MEDICARE: JOURNEY GREEN GUNTER

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	10995	NE

General Provider Information

NPI Number	:	1336820885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOURNEY GREEN GUNTER

Provider Business Mailing Address
First Line	:	6409 N 107TH CT
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 N 13TH ST
Second Line	:
City	:	CARTER LAKE
State	:	IA
Zip	:	51510-1438
Country	:	US
Telephone Number	:	402-679-7888
Fax Number	:

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

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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Directions to “ JOURNEY GREEN GUNTER ” Practice Location

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