Provider Demographics
NPI:1073578282
Name:LIEBENTRITT, NICHOLAS NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:NATHANIEL
Last Name:LIEBENTRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 NORTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1041
Mailing Address - Country:US
Mailing Address - Phone:402-572-6500
Mailing Address - Fax:402-572-6501
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:402-572-6500
Practice Address - Fax:402-572-6501
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23246207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI33293Medicare UPIN
NE278967Medicare ID - Type Unspecified