Provider Demographics
NPI:1306826375
Name:CORREA, PRISCILLA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:M
Last Name:CORREA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2703
Mailing Address - Country:US
Mailing Address - Phone:402-731-9100
Mailing Address - Fax:402-731-1297
Practice Address - Street 1:4828 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2703
Practice Address - Country:US
Practice Address - Phone:402-731-9100
Practice Address - Fax:402-731-1297
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1996959Medicaid
NE47080940101Medicaid
IA1996959Medicaid