Provider Demographics
NPI:1235029067
Name:MUGANGA, MARYAN OMER
Entity type:Individual
Prefix:
First Name:MARYAN
Middle Name:OMER
Last Name:MUGANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10911 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4610
Mailing Address - Country:US
Mailing Address - Phone:615-521-0689
Mailing Address - Fax:
Practice Address - Street 1:10933 ARLINGTON PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-4455
Practice Address - Country:US
Practice Address - Phone:615-521-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant