Healthcare Provider Details

I. General information

NPI: 1477362242
Provider Name (Legal Business Name): DIANA J VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 S 24TH ST
OMAHA NE
68107-1817
US

IV. Provider business mailing address

4519 S 24TH ST
OMAHA NE
68107-1817
US

V. Phone/Fax

Practice location:
  • Phone: 402-504-8299
  • Fax:
Mailing address:
  • Phone: 402-504-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: