Healthcare Provider Details

I. General information

NPI: 1083278790
Provider Name (Legal Business Name): STEPHANIE M MADDOX APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE M BITZES APRN

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 178TH ST
OMAHA NE
68118-3542
US

IV. Provider business mailing address

7100 W CENTER RD
OMAHA NE
68106-2714
US

V. Phone/Fax

Practice location:
  • Phone: 888-333-7520
  • Fax:
Mailing address:
  • Phone: 402-506-9000
  • Fax: 402-506-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112830
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77902
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: