Healthcare Provider Details

I. General information

NPI: 1609706209
Provider Name (Legal Business Name): MR. HAMISI MOHAMED OMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 N 61ST ST APT 13
OMAHA NE
68104-2055
US

IV. Provider business mailing address

4730 N 61ST ST APT 13
OMAHA NE
68104-2055
US

V. Phone/Fax

Practice location:
  • Phone: 402-215-6557
  • Fax:
Mailing address:
  • Phone: 402-215-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: