Provider Demographics
NPI:1164233250
Name:DIVETT, DONALD JOSEPH
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:DIVETT
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 1:16909 LAKESIDE HILLS PLZ STE 114
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4652
Mailing Address - Country:US
Mailing Address - Phone:402-932-2211
Mailing Address - Fax:
Practice Address - Street 1:8005 N 166TH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-2855
Practice Address - Country:US
Practice Address - Phone:505-917-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider