Healthcare Provider Details

I. General information

NPI: 1356259105
Provider Name (Legal Business Name): DONTELLE DAVID
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14816 MARY ST
OMAHA NE
68116-4403
US

IV. Provider business mailing address

3844 FRANKLIN ST
OMAHA NE
68111-4022
US

V. Phone/Fax

Practice location:
  • Phone: 402-312-4776
  • Fax:
Mailing address:
  • Phone: 402-312-4776
  • 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: