Healthcare Provider Details

I. General information

NPI: 1669745253
Provider Name (Legal Business Name): MARY MAUREEN GARVIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MAUREEN MCAULIFFE

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18018 BURKE ST
ELKHORN NE
68022-4417
US

IV. Provider business mailing address

18018 BURKE ST
ELKHORN NE
68022-4417
US

V. Phone/Fax

Practice location:
  • Phone: 402-573-7337
  • Fax: 402-614-2314
Mailing address:
  • Phone: 402-573-7337
  • Fax: 402-614-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: