Provider Demographics
NPI:1326076498
Name:ALT, MARY A (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:ALT
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:110 N 29TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4424
Mailing Address - Country:US
Mailing Address - Phone:402-844-8121
Mailing Address - Fax:402-844-8122
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-4828
Practice Address - Fax:402-844-8175
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-07-13
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Provider Licenses
StateLicense IDTaxonomies
NE110665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025561900Medicaid