MEDICARE: TARA ERNESTINE DORSEY RN

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	163WM1400X	Nurse Massage Therapist (NMT)	94079	NE

General Provider Information

NPI Number	:	1932031457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA ERNESTINE DORSEY RN

Provider Business Mailing Address
First Line	:	1740 N 84TH TER
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-2909
Country	:	US
Telephone Number	:	402-505-0549
Fax Number	:

Provider Business Practice Location Address
First Line	:	8550 INDIAN HILLS DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-4070
Country	:	US
Telephone Number	:	402-505-0549
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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