Individual
MISPA KELLYPRIDE BIH NGANTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2919 N 153RD CIR, OMAHA, NE 68116-8134
(402) 218-0808
Mailing address
2919 N 153RD CIR, OMAHA, NE 68116-8134
(402) 218-0808
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
115849
NE
Other
Enumeration date
02/20/2025
Last updated
02/20/2025
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