Provider Demographics
NPI:1275123549
Name:MOONEY, NICOLE LYNN (RN/BSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:MOONEY
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JOHNSON RD APT 302
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-6428
Mailing Address - Country:US
Mailing Address - Phone:402-720-9899
Mailing Address - Fax:
Practice Address - Street 1:420 E 11TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-5001
Practice Address - Country:US
Practice Address - Phone:402-652-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59362163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health