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General NPI Number Information
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NPI Number | 1508663386
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Entity Type | Individual
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Provider Name | PHILLIP TINNELL
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Gender | Male
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 7408 MICHELLE AVE
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City | LA VISTA
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State | NE
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Zip | 68128-2956
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Country | US
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Telephone | 402-331-9549
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Fax |
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Provider Business Mailing Address
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Address Line | 6818 GROVER ST STE 200
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City | OMAHA
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State | NE
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Zip | 68106-3632
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Country | US
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Telephone | 402-932-0072
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Fax | 402-614-8245
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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