Provider Demographics
NPI:1275370801
Name:CARNLEY, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CARNLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3039
Mailing Address - Country:US
Mailing Address - Phone:402-321-9580
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVE BLDG 9
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:402-995-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68539163WD1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Single Specialty