Healthcare Provider Details

I. General information

NPI: 1124221072
Provider Name (Legal Business Name): MARJORIE ANN CARON RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W DODGE RD SUITE # 30
OMAHA NE
68114-3457
US

IV. Provider business mailing address

800 S TAYLOR ST
PAPILLION NE
68046-3607
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-8797
  • Fax: 402-354-5651
Mailing address:
  • Phone: 402-592-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number20587
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: