Healthcare Provider Details

I. General information

NPI: 1275422735
Provider Name (Legal Business Name): NDUMU THOMAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HOGAN DR
PAPILLION NE
68046-2121
US

IV. Provider business mailing address

12522 PHEASANT RUN CIR
PAPILLION NE
68046-4005
US

V. Phone/Fax

Practice location:
  • Phone: 28-717-8694
  • Fax: 531-484-2788
Mailing address:
  • Phone: 402-871-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number62889
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: