Individual
PAE MU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4527 N 66TH ST APT 11, OMAHA, NE 68104-1954
(402) 401-0451
Mailing address
4527 N 66TH ST APT 11, OMAHA, NE 68104-1954
(402) 401-0451
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
NE
Other
Enumeration date
03/13/2025
Last updated
03/13/2025
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