Healthcare Provider Details

I. General information

NPI: 1104785161
Provider Name (Legal Business Name): LESLIE TITSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 REGENCY PARKWAY DR STE 134
OMAHA NE
68114-3742
US

IV. Provider business mailing address

4704 N 39TH ST
OMAHA NE
68111-2233
US

V. Phone/Fax

Practice location:
  • Phone: 402-359-1996
  • Fax:
Mailing address:
  • Phone: 402-905-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: