Provider Demographics
NPI:1346547007
Name:CICCONE, REBECCA (APRN-NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CICCONE
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4724
Mailing Address - Country:US
Mailing Address - Phone:402-902-9609
Mailing Address - Fax:
Practice Address - Street 1:201 CAPITOL BEACH BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-1645
Practice Address - Country:US
Practice Address - Phone:402-902-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily