Healthcare Provider Details

I. General information

NPI: 1326901190
Provider Name (Legal Business Name): MICHAEL MAWBY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N CHERRY ST
VALENTINE NE
69201-1500
US

IV. Provider business mailing address

5603 OAK HILLS DR
OMAHA NE
68137-3337
US

V. Phone/Fax

Practice location:
  • Phone: 479-644-7560
  • Fax:
Mailing address:
  • Phone: 479-644-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: