Healthcare Provider Details

I. General information

NPI: 1518893940
Provider Name (Legal Business Name): TYANA GRIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11314 ELM ST
OMAHA NE
68144-4733
US

IV. Provider business mailing address

12550 S 114TH ST
PAPILLION NE
68046-4256
US

V. Phone/Fax

Practice location:
  • Phone: 402-981-8593
  • Fax:
Mailing address:
  • Phone: 402-672-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: