Provider Demographics
NPI:1174928287
Name:MACK, HUONG X (APRN)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:X
Last Name:MACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HUONG
Other - Middle Name:X
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1600 S 70TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1568
Mailing Address - Country:US
Mailing Address - Phone:402-937-8323
Mailing Address - Fax:
Practice Address - Street 1:1600 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1568
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111737363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075636930Medicaid
NE10025734000Medicaid
NE10026038300Medicaid
NE47075636998Medicaid
NE10025734000Medicaid