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NPI Code Detail

MEDICARE: STEPHANIE M MADDOX APRN

MEDICARE: STEPHANIE M MADDOX APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner112830NE
2163W00000XRegistered Nurse77902NE

General Provider Information

NPI Number : 1083278790
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE M MADDOX APRN
Provider Business Mailing Address
First Line : 7100 W CENTER RD
Second Line :
City : OMAHA
State : NE
Zip : 68106-2714
Country : US
Telephone Number : 402-506-9000
Fax Number : 402-506-9093
Provider Business Practice Location Address
First Line : 1000 S 178TH ST
Second Line :
City : OMAHA
State : NE
Zip : 68118-3542
Country : US
Telephone Number : 888-333-7520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2019
Last Update Date : 12/04/2025

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