Healthcare Provider Details

I. General information

NPI: 1992669659
Provider Name (Legal Business Name): ROBERT DRAKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 HOGAN DR
PAPILLION NE
68046-2121
US

IV. Provider business mailing address

806 HOGAN DR
PAPILLION NE
68046-2121
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-3441
  • Fax: 531-484-2788
Mailing address:
  • Phone: 402-934-3441
  • Fax: 531-484-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: