Provider Demographics
NPI:1295547388
Name:WANGAI, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WANGAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 MORRIE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4091
Mailing Address - Country:US
Mailing Address - Phone:402-915-0499
Mailing Address - Fax:
Practice Address - Street 1:2710 MORRIE DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4091
Practice Address - Country:US
Practice Address - Phone:402-915-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 372600000X, 3747P1801X, 343900000X, 372500000X
NE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372500000XNursing Service Related ProvidersChore Provider