Healthcare Provider Details

I. General information

NPI: 1053230862
Provider Name (Legal Business Name): DIAMON BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 ERSKINE ST APT 5
OMAHA NE
68104-4159
US

IV. Provider business mailing address

5824 ERSKINE ST APT 5
OMAHA NE
68104-4159
US

V. Phone/Fax

Practice location:
  • Phone: 402-515-3988
  • Fax:
Mailing address:
  • Phone: 402-515-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: