Provider Demographics
NPI:1649169160
Name:LANUM, MARIAH KATE
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:KATE
Last Name:LANUM
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 1:11952 N 143RD ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-1165
Mailing Address - Country:US
Mailing Address - Phone:531-739-7107
Mailing Address - Fax:
Practice Address - Street 1:5801 HIDCOTE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5568
Practice Address - Country:US
Practice Address - Phone:402-665-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE161696156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist