Healthcare Provider Details

I. General information

NPI: 1720895816
Provider Name (Legal Business Name): MARY JO SPALDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SAINT MICHAELS RD
LINCOLN NE
68512-1850
US

IV. Provider business mailing address

1821 SAINT MICHAELS RD
LINCOLN NE
68512-1850
US

V. Phone/Fax

Practice location:
  • Phone: 402-720-8744
  • Fax:
Mailing address:
  • Phone: 402-720-8744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: