MIKAYLA K GREVENGOED

OMAHA, NE
NPI1215568175
Former NameMIKAYLA K LOCKE
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: NE  2429)
Additional Taxonomies363A00000X Physician Assistant
(Licence: IA  115612)
363AM0700X Physician Assistant, Medical
(Licence: NE  2429)
Enumeration Date2020-01-30
Last Update Date2023-05-13
Business Address
Mrs. MIKAYLA K GREVENGOED PA
8200 DODGE ST
OMAHA, NE 68114
Phone number: 402-955-5400
Mailing Address
Mrs. MIKAYLA K GREVENGOED PA
PO BOX 24607
OMAHA, NE 68124
Phone number: 402-955-5400