Provider Demographics
NPI:1023823416
Name:VINSTON, DRENAE D
Entity type:Individual
Prefix:
First Name:DRENAE
Middle Name:D
Last Name:VINSTON
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 1:6714 N 91ST PLZ APT C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-4181
Mailing Address - Country:US
Mailing Address - Phone:402-515-3387
Mailing Address - Fax:
Practice Address - Street 1:6714 N 91ST PLZ APT C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-4181
Practice Address - Country:US
Practice Address - Phone:402-515-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities