=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598616138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAURTIESHA HOLBERT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2026
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7200 S 84TH ST
-----------------------------------------------------
City | LA VISTA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68128-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-255-7764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3905 BUTTERFIELD RD
-----------------------------------------------------
City | BELLWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60104-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-494-8901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------