Provider Demographics
NPI:1770690521
Name:CHURCHILL, MARY K (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 O ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2466
Mailing Address - Country:US
Mailing Address - Phone:402-484-5600
Mailing Address - Fax:402-484-5630
Practice Address - Street 1:7441 O ST STE 304
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-484-5600
Practice Address - Fax:402-484-5630
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110291363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S55543Medicare UPIN