Healthcare Provider Details

I. General information

NPI: 1881491439
Provider Name (Legal Business Name): DEZHANAY HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 HARNEY ST STE 703
OMAHA NE
68102-2366
US

IV. Provider business mailing address

325 SCOTT ST
COUNCIL BLUFFS IA
51503-0756
US

V. Phone/Fax

Practice location:
  • Phone: 402-346-6164
  • Fax:
Mailing address:
  • Phone: 402-346-6164
  • Fax: 402-346-6928

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: