Provider Demographics
NPI:1184989873
Name:CARR, MINDY R (APRN)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:R
Last Name:CARR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:R
Other - Last Name:PEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:16929 FRANCES ST
Mailing Address - Street 2:STE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16929 FRANCES ST
Practice Address - Street 2:STE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4684
Practice Address - Country:US
Practice Address - Phone:402-758-5821
Practice Address - Fax:402-898-8355
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098611101OtherMEDICARE