Healthcare Provider Details

I. General information

NPI: 1164357661
Provider Name (Legal Business Name): WILLIAM PERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 DODGE ST STE 103
OMAHA NE
68131-3218
US

IV. Provider business mailing address

4505 LAFAYETTE AVE APT 5
OMAHA NE
68132-1778
US

V. Phone/Fax

Practice location:
  • Phone: 402-318-5581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: