Healthcare Provider Details

I. General information

NPI: 1629175682
Provider Name (Legal Business Name): NICHOLE THIES APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 W MAPLE RD
OMAHA NE
68164
US

IV. Provider business mailing address

13808 W MAPLE RD
OMAHA NE
68164-6231
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3000
  • Fax: 402-955-7055
Mailing address:
  • Phone: 402-955-3000
  • Fax: 402-955-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number110994
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: