Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 17774 | NE |
NPI | 1861571432 |
---|---|
Provider Name | Teri Jo Mauch |
First Address | Omaha, NE 68198-2165 |
Second Address | Omaha, NE 68198-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 07/06/2012 |