Provider Demographics
NPI:1164085759
Name:CECAVA, LOIS (RN)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:CECAVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2818
Mailing Address - Country:US
Mailing Address - Phone:308-436-3125
Mailing Address - Fax:308-436-4301
Practice Address - Street 1:1519 10TH ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2818
Practice Address - Country:US
Practice Address - Phone:308-436-3125
Practice Address - Fax:308-436-4301
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-6005311Medicaid