Healthcare Provider Details

I. General information

NPI: 1366240343
Provider Name (Legal Business Name): KAREN GUADALUPE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 N 63RD ST
OMAHA NE
68104-2023
US

IV. Provider business mailing address

7197 PINE ST
OMAHA NE
68106-2811
US

V. Phone/Fax

Practice location:
  • Phone: 531-389-5703
  • Fax:
Mailing address:
  • Phone: 531-325-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: