Healthcare Provider Details

I. General information

NPI: 1477066587
Provider Name (Legal Business Name): ANNA J CIDLIK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 ALLENDALE DR
LINCOLN NE
68516-1033
US

IV. Provider business mailing address

3430 ALLENDALE DR
LINCOLN NE
68516-1033
US

V. Phone/Fax

Practice location:
  • Phone: 402-890-3527
  • Fax:
Mailing address:
  • Phone: 402-890-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: