Individual
MRS. MIKAYLA K GREVENGOED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8200 DODGE ST, OMAHA, NE 68114
(402) 955-5400
(402) 955-4364
Mailing address
PO BOX 24607, OMAHA, NE 68124
(402) 955-5400
(402) 955-3674
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
115612
IA
363A00000X
Physician Assistant
Primary
2429
NE
363AM0700X
Medical Physician Assistant
2429
NE
Other
Enumeration date
01/30/2020
Last updated
05/13/2023
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