Healthcare Provider Details

I. General information

NPI: 1346547007
Provider Name (Legal Business Name): REBECCA CICCONE APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CAPITOL BEACH BLVD STE 1A
LINCOLN NE
68528-1645
US

IV. Provider business mailing address

4905 SHANNON DR
PAPILLION NE
68133-4724
US

V. Phone/Fax

Practice location:
  • Phone: 402-902-9609
  • Fax:
Mailing address:
  • Phone: 402-902-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111205
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: