MEDICARE: HUONG X MACK 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	111737	NE
2	363L00000X	Nurse Practitioner	111737	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174928287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUONG X MACK APRN

Provider Business Mailing Address
First Line	:	1600 S 70TH ST STE 200
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-1568
Country	:	US
Telephone Number	:	402-937-8323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S 70TH ST STE 200
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-1568
Country	:	US
Telephone Number	:	402-476-7557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	09/20/2023

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Directions to “ HUONG X MACK APRN” Practice Location

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