Provider Demographics
NPI:1093089401
Name:DOSTAL, NANCY L (RP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:DOSTAL
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WILDERNESS VIEW ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1158
Mailing Address - Country:US
Mailing Address - Phone:402-423-0573
Mailing Address - Fax:
Practice Address - Street 1:1404 SUPERIORT ST.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521
Practice Address - Country:US
Practice Address - Phone:402-477-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist