Healthcare Provider Details

I. General information

NPI: 1831161587
Provider Name (Legal Business Name): KAREN S STAACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W GRUENTHER RD
GRETNA NE
68028-4828
US

IV. Provider business mailing address

102 W GRUENTHER RD
GRETNA NE
68028-4828
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-2772
  • Fax: 402-332-5446
Mailing address:
  • Phone: 402-332-2772
  • Fax: 402-332-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21481
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: