Provider Demographics
NPI:1942314646
Name:KAUP, MARY (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KAUP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6971
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0971
Mailing Address - Country:US
Mailing Address - Phone:402-486-7029
Mailing Address - Fax:402-434-0736
Practice Address - Street 1:625 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2404
Practice Address - Country:US
Practice Address - Phone:402-484-6600
Practice Address - Fax:402-484-6610
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025104200Medicaid
NEP00664992Medicare PIN
NE099526001Medicare PIN