MEDICARE: DELORES ADELLA SPOTANSKI

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1275330722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELORES ADELLA SPOTANSKI

Provider Business Mailing Address
First Line	:	3937 NORSEMAN AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1578
Country	:	US
Telephone Number	:	308-379-1734
Fax Number	:

Provider Business Practice Location Address
First Line	:	4027 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1117
Country	:	US
Telephone Number	:	308-201-0282
Fax Number	:

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

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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