Healthcare Provider Details

I. General information

NPI: 1093811069
Provider Name (Legal Business Name): JANE M. CARNAZZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 S 50TH ST
OMAHA NE
68117-1332
US

IV. Provider business mailing address

8401 W DODGE RD SUITE 280
OMAHA NE
68114-3451
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-7474
  • Fax: 402-955-7476
Mailing address:
  • Phone: 402-955-6810
  • Fax: 402-955-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17583
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: