Provider Demographics
NPI:1063554137
Name:MAACK, MARJORIE B (PA)
Entity type:Individual
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First Name:MARJORIE
Middle Name:B
Last Name:MAACK
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Gender:F
Credentials:PA
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Mailing Address - Street 1:8303 DODGE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4108
Mailing Address - Country:US
Mailing Address - Phone:402-354-8124
Mailing Address - Fax:402-354-8127
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-8124
Practice Address - Fax:402-354-8127
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-02-08
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Provider Licenses
StateLicense IDTaxonomies
NE795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04199Medicare UPIN