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General NPI Number Information
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NPI Number | 1578682043
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Entity Type | Individual
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Provider Name | SHANNA MICHAELA NIEDBALSKI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3010 23RD ST
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City | COLUMBUS
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State | NE
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Zip | 68601-3122
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Country | US
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Telephone | 402-562-7668
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Fax | 402-563-0915
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Provider Business Mailing Address
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Address Line | 2653 PRAIRIE PL
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City | COLUMBUS
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State | NE
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Zip | 68601-2440
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Country | US
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Telephone | 402-606-4062
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12523
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License Number State | NE
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