Individual
SAMUEL ADAM MAURICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6715 S 180TH ST, OMAHA, NE 68135-1883
(531) 355-3358
(531) 355-3375
Mailing address
13460 WALSH DR, BOYS TOWN, NE 68010-7529
(531) 355-3358
(531) 355-3375
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
12168
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026522505
—
NE
05
—
47037660631
—
NE
Enumeration date
05/12/2020
Last updated
05/12/2020
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