Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 6989 | NE |
Y | 111NI0900X | Internist | 6989 | NE |
NPI | 1003256991 |
---|---|
Provider Name | Dr. Lauren C Licitra |
First Address | Omaha, NE 68198-0001 |
Second Address | Omaha, NE 68198-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 25/06/2013 |