Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 8594 | NE |
NPI | 1013474691 |
---|---|
Provider Name | Jocelyn Breanna Mulkey |
First Address | Omaha, NE 68198-4150 |
Second Address | Omaha, NE 68198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 21/06/2019 |