Healthcare Provider Details

I. General information

NPI: 1679395289
Provider Name (Legal Business Name): EMILY XUAN TRUC LY BUI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14460 W MAPLE RD
OMAHA NE
68116-5163
US

IV. Provider business mailing address

14460 W MAPLE RD
OMAHA NE
68116-5163
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 563-589-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3392
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: