Provider Demographics
NPI:1548290471
Name:SHREVE, MARJORIE R (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:R
Last Name:SHREVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4242 FARNAM ST
Mailing Address - Street 2:#150
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-6747
Mailing Address - Fax:402-552-6741
Practice Address - Street 1:304 N 168TH CIR
Practice Address - Street 2:#211
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-4091
Practice Address - Country:US
Practice Address - Phone:402-289-9325
Practice Address - Fax:402-289-9829
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE21276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025310200Medicaid
IA0596700Medicaid
NE279481Medicare ID - Type Unspecified