Healthcare Provider Details

I. General information

NPI: 1730306549
Provider Name (Legal Business Name): JOAN DAUGHTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 DAVENPORT ST STE 101
OMAHA NE
68154-2690
US

IV. Provider business mailing address

11235 DAVENPORT ST STE 101
OMAHA NE
68154-2690
US

V. Phone/Fax

Practice location:
  • Phone: 402-251-5115
  • Fax: 866-272-0225
Mailing address:
  • Phone: 402-251-5115
  • Fax: 866-272-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23375
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number23375
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: