Healthcare Provider Details

I. General information

NPI: 1558224022
Provider Name (Legal Business Name): DOROTHEA CONNOLLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

233 S WASHINGTON ST STE 101
PAPILLION NE
68046-2449
US

IV. Provider business mailing address

8902 HONEY LOCUST DR
LA VISTA NE
68128-2823
US

V. Phone/Fax

Practice location:
  • Phone: 402-907-5659
  • Fax:
Mailing address:
  • Phone: 402-907-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: