Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 22805 | NE |
NPI | 1255360491 |
---|---|
Provider Name | Nicolle M Mahoney |
First Address | Lincoln, NE 68506-1225 |
Second Address | Lincoln, NE 68506-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4705966613 | (05) | NE |
I07903 | (02) |