Provider Demographics
NPI:1952116816
Name:ANTONETTY, LAKISHA DONEA
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:DONEA
Last Name:ANTONETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKISHA
Other - Middle Name:DONEA
Other - Last Name:REIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10013 S 202ND CIR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4559
Mailing Address - Country:US
Mailing Address - Phone:402-802-8456
Mailing Address - Fax:
Practice Address - Street 1:10013 S 202ND CIR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4559
Practice Address - Country:US
Practice Address - Phone:402-802-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE272203747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant