Healthcare Provider Details

I. General information

NPI: 1780874826
Provider Name (Legal Business Name): NEBRASKA MEDICAL AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9802 NICHOLAS ST SUITE 305
OMAHA NE
68114-2106
US

IV. Provider business mailing address

9802 NICHOLAS ST SUITE 305
OMAHA NE
68114-2106
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-2300
  • Fax: 402-397-2303
Mailing address:
  • Phone: 402-397-2300
  • Fax: 402-397-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JULIE L WADDELL
Title or Position: DIRECTOR
Credential: MD
Phone: 402-397-2300