Provider Demographics
NPI:1720882145
Name:MUMPHREY, MARQUETTA
Entity type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:
Last Name:MUMPHREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10917 JAYNES PLZ APT 1832
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-4424
Mailing Address - Country:US
Mailing Address - Phone:402-671-4496
Mailing Address - Fax:
Practice Address - Street 1:1820 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3636
Practice Address - Country:US
Practice Address - Phone:402-682-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant