Provider Demographics
NPI:1912193897
Name:HEPBURN, GREGORY NATHANIEL JR (MS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:NATHANIEL
Last Name:HEPBURN
Suffix:JR
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13508 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4754
Mailing Address - Country:US
Mailing Address - Phone:402-658-3250
Mailing Address - Fax:
Practice Address - Street 1:9001 ARBOR ST STE 206
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2066
Practice Address - Country:US
Practice Address - Phone:402-718-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8464101YM0800X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health