Provider Demographics
NPI:1184300733
Name:FIALA, MARY MARGARET
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:FIALA
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 1:701 PINNACLE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6228
Mailing Address - Country:US
Mailing Address - Phone:402-646-0197
Mailing Address - Fax:
Practice Address - Street 1:2471 336TH RD
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:NE
Practice Address - Zip Code:68669-6907
Practice Address - Country:US
Practice Address - Phone:402-646-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program