Healthcare Provider Details

I. General information

NPI: 1225835564
Provider Name (Legal Business Name): ZYEMARA MOUNTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 HARNEY ST STE 703
OMAHA NE
68102-2366
US

IV. Provider business mailing address

6819 B PLZ APT 94
OMAHA NE
68106-4222
US

V. Phone/Fax

Practice location:
  • Phone: 402-346-6164
  • Fax: 402-346-6928
Mailing address:
  • Phone: 402-346-6164
  • 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: