MEDICARE: POR PU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1033924170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POR PU

Provider Business Mailing Address
First Line	:	6630 LAUREL AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-1042
Country	:	US
Telephone Number	:	402-238-8007
Fax Number	:

Provider Business Practice Location Address
First Line	:	6630 LAUREL AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-1042
Country	:	US
Telephone Number	:	402-238-8007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “ POR PU ” Practice Location

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