Healthcare Provider Details

I. General information

NPI: 1073422101
Provider Name (Legal Business Name): HALLIE LEILA GOUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 HAZEL LN
SPRINGFIELD NE
68059-5740
US

IV. Provider business mailing address

2015 BURT ST DAVIS SQUARE CREIGHTON UNIVERSITY
OMAHA NE
68178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-392-0117
  • Fax:
Mailing address:
  • Phone: 520-392-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: