Provider Demographics
NPI:1679452825
Name:VINCENTINI, KYLE CHRISTIAN
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CHRISTIAN
Last Name:VINCENTINI
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 1:10341 ROCKBROOK RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1852
Mailing Address - Country:US
Mailing Address - Phone:402-681-4569
Mailing Address - Fax:
Practice Address - Street 1:10341 ROCKBROOK RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1852
Practice Address - Country:US
Practice Address - Phone:402-681-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant