Provider Demographics
NPI:1730077876
Name:GATES-COLBERT, FANTASHIA
Entity type:Individual
Prefix:
First Name:FANTASHIA
Middle Name:
Last Name:GATES-COLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 JONES ST STE 515
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-3248
Mailing Address - Country:US
Mailing Address - Phone:402-319-1089
Mailing Address - Fax:
Practice Address - Street 1:5624 N 52ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1806
Practice Address - Country:US
Practice Address - Phone:402-235-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker