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General NPI Number Information
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NPI Number | 1316430655
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Entity Type | Individual
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Provider Name | DR. ALYSSA NICOLE LEBOEUF
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 1265 S COTNER BLVD STE 1
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City | LINCOLN
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State | NE
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Zip | 68510-4924
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Country | US
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Telephone | 402-904-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 8730 FREMONT STREET APT. 120
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City | LINCOLN
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State | NE
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Zip | 68507
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Country | US
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Telephone | 620-704-3242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7465
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License Number State | NE
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