Healthcare Provider Details

I. General information

NPI: 1023534823
Provider Name (Legal Business Name): MARY OPP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 Q ST
LINCOLN NE
68503-3643
US

IV. Provider business mailing address

2633 P ST
LINCOLN NE
68503-3528
US

V. Phone/Fax

Practice location:
  • Phone: 402-904-4320
  • Fax:
Mailing address:
  • Phone: 402-475-8717
  • Fax: 402-475-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number51404
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: