Healthcare Provider Details

I. General information

NPI: 1003615931
Provider Name (Legal Business Name): MARY BETH SLADEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 ARBOR ST STE 110
OMAHA NE
68144-5000
US

IV. Provider business mailing address

811 N 121ST ST APT 60
OMAHA NE
68154-1480
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: