Healthcare Provider Details

I. General information

NPI: 1184300733
Provider Name (Legal Business Name): MARY MARGARET FIALA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 S 132ND ST STE 100
OMAHA NE
68144-2573
US

IV. Provider business mailing address

2255 S 132ND ST STE 100
OMAHA NE
68144-2573
US

V. Phone/Fax

Practice location:
  • Phone: 402-646-0197
  • Fax: 402-226-4827
Mailing address:
  • Phone: 402-671-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: