Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | RL10954 | ND |
Y | 207V00000X | Obstetrician & Gynecologist | 11358 | ND |
N | 207V00000X | Obstetrician & Gynecologist | 7357 | NE |
NPI | 1013163963 |
---|---|
Provider Name | Mary M. Nybakken |
First Address | Omaha, NE 68198-3255 |
Second Address | Fargo, ND 58104-7927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12083 | (05) | ND |