Healthcare Provider Details

I. General information

NPI: 1093383192
Provider Name (Legal Business Name): KATHERINE ELIZABETH MERRITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

IV. Provider business mailing address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-8111
  • Fax: 402-717-8127
Mailing address:
  • Phone: 402-717-8111
  • Fax: 402-717-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9040
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36273
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: