Individual
KYLIE NICOLE MASKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4014 LEAVENWORTH ST, OMAHA, NE 68105-1026
(402) 559-5208
Mailing address
18802 GREENLEAF ST, OMAHA, NE 68136-1708
(308) 627-1897
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3212
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/27/2023
Last updated
02/12/2025
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