Healthcare Provider Details

I. General information

NPI: 1598849440
Provider Name (Legal Business Name): MERYL A SEVERSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 DODGE ST
OMAHA NE
68132-3234
US

IV. Provider business mailing address

4610 DODGE ST
OMAHA NE
68132-3234
US

V. Phone/Fax

Practice location:
  • Phone: 402-306-8056
  • Fax: 402-554-1805
Mailing address:
  • Phone: 402-306-8056
  • Fax: 402-554-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number24963
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number19357
License Number StateNE

VIII. Authorized Official

Name: MRS. LINDA BEIRIGER
Title or Position: VP MEDICAL SERVICES
Credential: MBA
Phone: 402-554-1103