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Individual

NIA BACON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4101 WOOLWORTH AVE, OMAHA, NE 68105-1850
(402) 346-8800
Mailing address
12227 S 33RD ST, BELLEVUE, NE 68123-1696
(973) 380-3171

Taxonomy

Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
NE

Other

Enumeration date
10/14/2025
Last updated
10/14/2025
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