Individual
TA MU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15505 KING CIR, BENNINGTON, NE 68007-1818
(385) 216-9877
Mailing address
3031 N 93RD ST, OMAHA, NE 68134-4715
(531) 800-5326
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
03/12/2025
Last updated
03/12/2025
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