MEDICARE: MRS. ANAYELEM MANDAO 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1881497139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANAYELEM MANDAO II

Provider Business Mailing Address
First Line	:	6707 N 155TH TERRACE PLZ APT 4209
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-4614
Country	:	US
Telephone Number	:	402-591-0732
Fax Number	:	531-201-4505

Provider Business Practice Location Address
First Line	:	6707 N 155TH TERRACE PLZ APT 4209
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-4614
Country	:	US
Telephone Number	:	402-591-0732
Fax Number	:	531-201-4505

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

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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