Healthcare Provider Details

I. General information

NPI: 1588226062
Provider Name (Legal Business Name): NATHALIE KHOURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982000 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2000
US

IV. Provider business mailing address

982000 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2000
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6040
  • Fax:
Mailing address:
  • Phone: 402-559-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number8407
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: