MEDICARE: MRS. HYNALEM HOTH TUT II

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043014178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HYNALEM HOTH TUT II

Provider Business Mailing Address
First Line	:	3308 N 43RD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-3002
Country	:	US
Telephone Number	:	402-871-0447
Fax Number	:	531-201-4505

Provider Business Practice Location Address
First Line	:	3308 N 43RD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-3002
Country	:	US
Telephone Number	:	402-871-0447
Fax Number	:	531-201-4505

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

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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