MEDICARE: NADOTH WIYUAL DOL

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		NE

General Provider Information

NPI Number	:	1124909890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADOTH WIYUAL DOL

Provider Business Mailing Address
First Line	:	13057 W CENTER RD STE 21
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-3723
Country	:	US
Telephone Number	:	402-741-6204
Fax Number	:

Provider Business Practice Location Address
First Line	:	13057 W CENTER RD STE 21
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-3723
Country	:	US
Telephone Number	:	402-741-6204
Fax Number	:

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

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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Directions to “ NADOTH WIYUAL DOL ” Practice Location

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