Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 74208 | NE |
NPI | 1003459728 |
---|---|
Provider Name | Michaela Joanne Mohr |
First Address | Norfolk, NE 68701-4424 |
Second Address | Norfolk, NE 68701-4424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 25/10/2019 |