Healthcare Provider Details

I. General information

NPI: 1619865698
Provider Name (Legal Business Name): MARIN EMILY BECKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13919 S PLZ
OMAHA NE
68137-2916
US

IV. Provider business mailing address

9419 N 30TH ST
OMAHA NE
68112-1544
US

V. Phone/Fax

Practice location:
  • Phone: 402-896-9988
  • Fax:
Mailing address:
  • Phone: 402-301-8939
  • Fax: 402-301-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number123456
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: