Provider Demographics
NPI:1417394636
Name:MCCOLLOUGH, MARIBETH (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIBETH
Middle Name:
Last Name:MCCOLLOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARIBETH
Other - Middle Name:
Other - Last Name:KRESL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12565 W CENTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3802
Mailing Address - Country:US
Mailing Address - Phone:402-342-5566
Mailing Address - Fax:402-342-0034
Practice Address - Street 1:12565 W CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3802
Practice Address - Country:US
Practice Address - Phone:402-342-5566
Practice Address - Fax:402-342-0034
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse