Provider Demographics
NPI:1811794027
Name:MUMTAZ, ERUM
Entity type:Individual
Prefix:
First Name:ERUM
Middle Name:
Last Name:MUMTAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14214 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1208
Mailing Address - Country:US
Mailing Address - Phone:402-612-6500
Mailing Address - Fax:
Practice Address - Street 1:14214 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1208
Practice Address - Country:US
Practice Address - Phone:402-612-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant