MEDICARE: PLO SOE

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	372500000X	Chore Provider		NE

General Provider Information

NPI Number	:	1396545802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PLO SOE

Provider Business Mailing Address
First Line	:	4921 BROWNE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-2324
Country	:	US
Telephone Number	:	531-800-3687
Fax Number	:

Provider Business Practice Location Address
First Line	:	4921 BROWNE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-2324
Country	:	US
Telephone Number	:	531-800-3687
Fax Number	:

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

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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Directions to “ PLO SOE ” Practice Location

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