Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 412 | NE |
NPI | 1023193190 |
---|---|
Provider Name | Dr. Mark Shriver |
First Address | Omaha, NE 68198-5450 |
Second Address | Omaha, NE 68198-5450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025287200 | (05) | NE |
S58102 | (02) | NE |