Healthcare Provider Details

I. General information

NPI: 1871919555
Provider Name (Legal Business Name): EMILY ANNE MAHON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 S 142ND ST
OMAHA NE
68137-2800
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-1001
  • Fax: 402-354-1910
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2160
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: