Healthcare Provider Details

I. General information

NPI: 1740115674
Provider Name (Legal Business Name): MARIAM SANKANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S 148TH CT APT 4104
OMAHA NE
68144-3324
US

IV. Provider business mailing address

3815 S 148TH CT APT 4104
OMAHA NE
68144-3324
US

V. Phone/Fax

Practice location:
  • Phone: 720-750-0468
  • Fax: 720-750-0468
Mailing address:
  • Phone: 720-750-0468
  • Fax: 720-750-0468

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: