Healthcare Provider Details

I. General information

NPI: 1669901765
Provider Name (Legal Business Name): LAUREL DUBA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 S 70TH ST STE 140
LINCOLN NE
68516-4276
US

IV. Provider business mailing address

8200 RENATTA DRIVE #1103
LINCOLN NE
68516
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-5100
  • Fax:
Mailing address:
  • Phone: 402-852-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number72499
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number112268
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: