Healthcare Provider Details

I. General information

NPI: 1508667254
Provider Name (Legal Business Name): MARY GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 LAS VERDES LN
LINCOLN NE
68523-9348
US

IV. Provider business mailing address

6040 LAS VERDES LN
LINCOLN NE
68523-9348
US

V. Phone/Fax

Practice location:
  • Phone: 240-408-1641
  • Fax:
Mailing address:
  • Phone: 240-408-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number96838
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: