Healthcare Provider Details

I. General information

NPI: 1750158473
Provider Name (Legal Business Name): MOLLY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17675 WELCH PLZ
OMAHA NE
68135-3551
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-7600
  • Fax: 23-547-6054
Mailing address:
  • Phone: 402-354-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023060270
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: