Healthcare Provider Details

I. General information

NPI: 1497543284
Provider Name (Legal Business Name): MARVIN TORRELL MCEWEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13906 GOLD CIR STE 100
OMAHA NE
68144-2336
US

IV. Provider business mailing address

9850 EMILINE PLZ APT D205
LA VISTA NE
68128-7091
US

V. Phone/Fax

Practice location:
  • Phone: 402-706-0772
  • Fax:
Mailing address:
  • Phone: 402-769-5071
  • 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: