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General NPI Number Information
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NPI Number | 1477290666
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Entity Type | Individual
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Provider Name | DENNIS NIETO
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Gender | Male
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 5801 N 33RD ST
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City | LINCOLN
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State | NE
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Zip | 68504-4665
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Country | US
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Telephone | 402-435-1305
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 FLAGSTONE RD
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City | LINCOLN
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State | NE
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Zip | 68521-5856
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Country | US
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Telephone | 773-678-0940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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