Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 110341 | NE |
NPI | 1629052154 |
---|---|
Provider Name | Mary Cammack |
First Address | Lincoln, NE 68502-3796 |
Second Address | Lincoln, NE 68502-3796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P10023 | (02) | NE |