Healthcare Provider Details

I. General information

NPI: 1588324768
Provider Name (Legal Business Name): DANIEL MEINKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

3225 W PERSHING RD
LINCOLN NE
68502-4844
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-4456
  • Fax:
Mailing address:
  • Phone: 402-641-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113987
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: