Healthcare Provider Details

I. General information

NPI: 1396882916
Provider Name (Legal Business Name): JOSE GARY B NADALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST STE 410
LINCOLN NE
68502-3785
US

IV. Provider business mailing address

2222 S 16TH ST STE 410
LINCOLN NE
68502-3785
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-1511
  • Fax: 402-474-1611
Mailing address:
  • Phone: 402-474-1511
  • Fax: 402-474-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number22502
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: