Healthcare Provider Details

I. General information

NPI: 1962181776
Provider Name (Legal Business Name): LOBO PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/05/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5539 S 27TH ST STE 101
LINCOLN NE
68512-1600
US

IV. Provider business mailing address

6255 SW 58TH ST
DENTON NE
68339-3375
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-6212
  • Fax:
Mailing address:
  • Phone: 619-993-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAMELA V WOLFE
Title or Position: PMHNP-BC, FNP-BC
Credential: DNP, APRN
Phone: 619-993-6004