Provider Demographics
NPI:1194515866
Name:STOPAK, MEMORY TERILEE (RN)
Entity type:Individual
Prefix:
First Name:MEMORY
Middle Name:TERILEE
Last Name:STOPAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16070 280TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-6325
Mailing Address - Country:US
Mailing Address - Phone:402-669-6950
Mailing Address - Fax:402-669-6950
Practice Address - Street 1:17022 280TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-6387
Practice Address - Country:US
Practice Address - Phone:402-910-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE66030230Medicaid