Provider Demographics
NPI:1275761868
Name:GERALDINE NESVAN M.A.P.C.
Entity Type:Organization
Organization Name:GERALDINE NESVAN M.A.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NESVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC
Authorized Official - Phone:402-493-4444
Mailing Address - Street 1:10506 BURT CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2094
Mailing Address - Country:US
Mailing Address - Phone:402-493-4444
Mailing Address - Fax:402-493-1550
Practice Address - Street 1:10506 BURT CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2094
Practice Address - Country:US
Practice Address - Phone:402-493-4444
Practice Address - Fax:402-493-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08189OtherBCBS
08189OtherBCBS
NE=========00Medicaid