Healthcare Provider Details

I. General information

NPI: 1558275545
Provider Name (Legal Business Name): JESSE COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5828 LAFAYETTE AVE
OMAHA NE
68132-1337
US

IV. Provider business mailing address

5828 LAFAYETTE AVE
OMAHA NE
68132-1337
US

V. Phone/Fax

Practice location:
  • Phone: 531-215-6455
  • Fax:
Mailing address:
  • Phone: 531-495-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: