Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 21893 | NE |
NPI | 1245280361 |
---|---|
Provider Name | Nils A Nystrom |
First Address | Omaha, NE 68198-8095 |
Second Address | Omaha, NE 68198-8095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557586 | (05) | NE |
G86926 | (02) | NE |