Provider Demographics
NPI:1306645262
Name:EDGMAN, GREG LEE
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:LEE
Last Name:EDGMAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 16TH ST APT 703
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1634
Mailing Address - Country:US
Mailing Address - Phone:531-203-3201
Mailing Address - Fax:
Practice Address - Street 1:1613 FARNAM ST APT 202
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2148
Practice Address - Country:US
Practice Address - Phone:531-203-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEC020080453747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant