Healthcare Provider Details

I. General information

NPI: 1780588004
Provider Name (Legal Business Name): MAYURI KANJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 CREEK SIDE DR STE 115
PAPILLION NE
68046-5103
US

IV. Provider business mailing address

2063 CREEK SIDE DR STE 115
PAPILLION NE
68046-5103
US

V. Phone/Fax

Practice location:
  • Phone: 402-505-9657
  • Fax: 402-505-9658
Mailing address:
  • Phone: 402-505-9657
  • Fax: 402-505-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3526
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: