Individual
ERICA LEE NICKESON HAAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2444 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4327
(308) 382-1100
(308) 385-0796
Mailing address
2444 W FAIDLEY AVE, P O BOX 550, GRAND ISLAND, NE 68803-4327
(308) 382-1100
(308) 385-0796
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
25132
OK
207VX0000X
Obstetrics Physician
Primary
25657
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47017633016
—
NE
01
—
CO4245
RR MEDICARE
NE
Enumeration date
01/24/2007
Last updated
11/13/2023
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