Individual
NICOLE M. LIEBENTRITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10020 NICHOLAS STREET, SUITE 202, OMAHA, NE 68114
(402) 393-2023
(402) 393-3244
Mailing address
10020 NICHOLAS STREET, SUITE 202, OMAHA, NE 68114-2188
(402) 393-2023
(402) 393-3244
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
23233
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01907
BC/BS GROUP
NE
01
—
05-00454
SHARE ADVANTAGE - BERGAN
NE
01
—
05-00466
SHARE ADVANTAGE LAKESIDE
NE
01
—
0592485
MEDICAID INDIVIDUAL
IA
01
—
247248
MIDLANDS CHOICE
NE
01
—
30039
BC/BS INDIVIDUAL
NE
01
—
470542490
TRICARE GROUP
NE
05
—
47054249012
—
NE
05
—
47054249013
—
NE
01
—
P00239606
RR MEDICARE INDIVIDUAL
NE
Enumeration date
07/25/2006
Last updated
08/21/2018
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