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General NPI Number Information
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NPI Number | 1033013123
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Entity Type | Individual
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Provider Name | BRIAN MAHAN
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Gender | Male
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 2609 VICTORIA AVE UNIT 646
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City | BELLEVUE
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State | NE
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Zip | 68005-3067
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Country | US
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Telephone | 402-251-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 4947 E HULL AVE
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City | DES MOINES
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State | IA
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Zip | 50317-2600
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Country | US
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Telephone | 515-339-3221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | NE
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