MEDICARE: MAYRA FLORES BOLANOS

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	:	1912886698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA FLORES BOLANOS

Provider Business Mailing Address
First Line	:	1408 FORT CROOK RD
Second Line	:	3RD FLOOR
City	:	BELLEVUE
State	:	NE
Zip	:	68005-3061
Country	:	US
Telephone Number	:	402-990-2149
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 FORT CROOK RD
Second Line	:	3RD FLOOR
City	:	BELLEVUE
State	:	NE
Zip	:	68005-3061
Country	:	US
Telephone Number	:	402-347-0007
Fax Number	:

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “ MAYRA FLORES BOLANOS ” Practice Location

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