Healthcare Provider Details

I. General information

NPI: 1841454105
Provider Name (Legal Business Name): REBECCA MARIE GOODBAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 70TH ST
LINCOLN NE
68510-2462
US

IV. Provider business mailing address

10150 N 150TH ST
WAVERLY NE
68462-1595
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-7420
  • Fax:
Mailing address:
  • Phone: 402-499-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number110949
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: