Provider Demographics
NPI:1033410337
Name:DE FINI, NICOLE MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELE
Last Name:DE FINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17841 PIERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1035
Mailing Address - Country:US
Mailing Address - Phone:402-991-7000
Mailing Address - Fax:
Practice Address - Street 1:17841 PIERCE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-1035
Practice Address - Country:US
Practice Address - Phone:402-991-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1088363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical