Individual
DR. NICHOLAS ANTHONY DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7710 MERCY RD STE 202, OMAHA, NE 68124-2353
(402) 280-4195
Mailing address
7710 MERCY RD STE 202, OMAHA, NE 68124-2353
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
8835
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8835
TEMPORARY EDUCATIONAL PERMIT
NE
Enumeration date
07/01/2020
Last updated
07/01/2020
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