Provider Demographics
NPI:1124209168
Name:HEJTMANEK, NICHOLE R (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:R
Last Name:HEJTMANEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 A ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4970
Mailing Address - Country:US
Mailing Address - Phone:402-488-5600
Mailing Address - Fax:402-488-7649
Practice Address - Street 1:5055 A ST STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4970
Practice Address - Country:US
Practice Address - Phone:402-488-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04718207Y00000X
390200000X
NE1124209168207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program