Provider Demographics
NPI:1073214359
Name:MABIN, CLARENCE LEE JR (BACHELORS OF ARTS)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:LEE
Last Name:MABIN
Suffix:JR
Gender:M
Credentials:BACHELORS OF ARTS
Other - Prefix:MR
Other - First Name:CLARENCE
Other - Middle Name:LEE
Other - Last Name:MABIN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5905 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2235
Mailing Address - Country:US
Mailing Address - Phone:402-436-1905
Mailing Address - Fax:
Practice Address - Street 1:5905 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2235
Practice Address - Country:US
Practice Address - Phone:402-436-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider