Healthcare Provider Details

I. General information

NPI: 1861700296
Provider Name (Legal Business Name): NICOLE ELAINE RADTKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 VALLEY RD STE 350
LINCOLN NE
68510-4844
US

IV. Provider business mailing address

815 K ST
LINCOLN NE
68508-2960
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-0011
  • Fax: 402-474-0012
Mailing address:
  • Phone: 402-474-0011
  • Fax: 402-474-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2443
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3875
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: