Healthcare Provider Details

I. General information

NPI: 1114841418
Provider Name (Legal Business Name): MACKENZIE ANN GILLWAY APRN-NURSE PRACTITIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 BOYS TOWN HOSPITAL RD
BOYS TOWN NE
68010-7513
US

IV. Provider business mailing address

1210 N 131ST AVE
OMAHA NE
68154-1268
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-1234
  • Fax:
Mailing address:
  • Phone: 402-943-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number117137
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: