Provider Demographics
NPI:1417968330
Name:GRABOW, JUDITH DIANE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:DIANE
Last Name:GRABOW
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3796
Mailing Address - Country:US
Mailing Address - Phone:402-483-8555
Mailing Address - Fax:402-483-8554
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-483-8555
Practice Address - Fax:402-483-8554
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE354897000OtherMAGELLAN PROVIDER NUMBER
NE354897000OtherMAGELLAN PROVIDER NUMBER