Provider Demographics
NPI:1558243303
Name:PINAMONG, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PINAMONG
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 1:13205 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-4319
Mailing Address - Country:US
Mailing Address - Phone:531-250-2320
Mailing Address - Fax:
Practice Address - Street 1:13205 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-4319
Practice Address - Country:US
Practice Address - Phone:531-250-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant