Healthcare Provider Details

I. General information

NPI: 1801724307
Provider Name (Legal Business Name): TAMIA MALLORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 S 93RD CIR
OMAHA NE
68127-2406
US

IV. Provider business mailing address

4060 VINTON ST STE 100
OMAHA NE
68105-3863
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-2308
  • Fax:
Mailing address:
  • Phone: 402-991-9880
  • 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: