Healthcare Provider Details

I. General information

NPI: 1912219429
Provider Name (Legal Business Name): MARILYN MARIE MCGARY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 N 24TH ST
OMAHA NE
68110-2252
US

IV. Provider business mailing address

2505 N 24TH ST
OMAHA NE
68110-2252
US

V. Phone/Fax

Practice location:
  • Phone: 402-451-5549
  • Fax:
Mailing address:
  • Phone: 402-451-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number39546
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: