Provider Demographics
NPI:1871390807
Name:GARANG, MARY BUYU
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BUYU
Last Name:GARANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 APPLEWOOD DR APT B103
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-7612
Mailing Address - Country:US
Mailing Address - Phone:402-490-5535
Mailing Address - Fax:
Practice Address - Street 1:1214 APPLEWOOD DR APT B103
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-7612
Practice Address - Country:US
Practice Address - Phone:402-490-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor