Healthcare Provider Details

I. General information

NPI: 1265340392
Provider Name (Legal Business Name): ETHAN ERIC GOETZINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8314 BOYD ST
OMAHA NE
68134-4224
US

IV. Provider business mailing address

16069 SPRAGUE ST
OMAHA NE
68116-2829
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-1140
  • Fax:
Mailing address:
  • Phone: 531-299-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: