Healthcare Provider Details

I. General information

NPI: 1962390997
Provider Name (Legal Business Name): COREY ANTHONY VEASLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 MAPLE ST
OMAHA NE
68111-3459
US

IV. Provider business mailing address

4127 MAPLE ST
OMAHA NE
68111-3459
US

V. Phone/Fax

Practice location:
  • Phone: 402-672-0482
  • Fax:
Mailing address:
  • Phone: 402-672-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberH12270555
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberH12270555
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: