Healthcare Provider Details

I. General information

NPI: 1700748399
Provider Name (Legal Business Name): ALICIA HAIDE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 O ST
LINCOLN NE
68510-2235
US

IV. Provider business mailing address

5905 O ST
LINCOLN NE
68510-2235
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1000
  • Fax:
Mailing address:
  • Phone: 402-436-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: