Healthcare Provider Details

I. General information

NPI: 1356245781
Provider Name (Legal Business Name): MISS SAMUELLA Y CHARCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 FARNAM ST APT 342
OMAHA NE
68102-1983
US

IV. Provider business mailing address

1920 FARNAM ST APT 342
OMAHA NE
68102-1983
US

V. Phone/Fax

Practice location:
  • Phone: 202-489-9656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number164090
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: