Healthcare Provider Details

I. General information

NPI: 1336347616
Provider Name (Legal Business Name): GREGORY LEE NABITY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 E 31ST ST
WAHOO NE
68066-5581
US

IV. Provider business mailing address

2540 N HEALTHY WAY
FREMONT NE
68025-2315
US

V. Phone/Fax

Practice location:
  • Phone: 402-277-5091
  • Fax:
Mailing address:
  • Phone: 402-727-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number485
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: