Healthcare Provider Details

I. General information

NPI: 1235067232
Provider Name (Legal Business Name): JOH BU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 FILLMORE ST
OMAHA NE
68122-3901
US

IV. Provider business mailing address

4911 N 64TH ST
OMAHA NE
68104-1908
US

V. Phone/Fax

Practice location:
  • Phone: 531-297-4326
  • Fax:
Mailing address:
  • Phone: 531-495-7636
  • Fax: 531-495-7636

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: