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Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
339 N 78TH ST, OMAHA, NE 68114-3640
(402) 315-3788
(402) 614-1033
Mailing address
PO BOX 24223, OMAHA, NE 68124-0223
(402) 315-3788
(402) 614-1033

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
110706
NE
363LA2200X
Adult Health Nurse Practitioner
Primary
110706
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10024986600
NE
Enumeration date
07/27/2006
Last updated
10/22/2014
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