Provider Demographics
NPI:1649910100
Name:GRABER, MARYBETH (RN)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:GRABER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:126 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:NE
Mailing Address - Zip Code:68710-5141
Mailing Address - Country:US
Mailing Address - Phone:402-635-2484
Mailing Address - Fax:
Practice Address - Street 1:126 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:NE
Practice Address - Zip Code:68710-5141
Practice Address - Country:US
Practice Address - Phone:402-635-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64159163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice