Healthcare Provider Details

I. General information

NPI: 1689173924
Provider Name (Legal Business Name): OMAHA FERTILITY & GYNECOLOGY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 S 96TH ST
OMAHA NE
68127-1202
US

IV. Provider business mailing address

615 N 159TH ST
OMAHA NE
68118-2211
US

V. Phone/Fax

Practice location:
  • Phone: 402-630-6485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARASEN PAUPOO
Title or Position: PHYSICIAN
Credential: MD, MA, FACOG
Phone: 402-630-6485