Provider Demographics
NPI:1457323925
Name:HERBSTER, STACEY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:HERBSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42ND @ DEWEY ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1023
Practice Address - Country:US
Practice Address - Phone:402-552-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD45702084P0800X
MI43010954062084P0800X
NE322582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995938OtherBLUE CROSS
MN040121002OtherPRIMEWEST
SD412991022531OtherPREFERRED ONE
SD16326OtherMIDLANDS CHOICE
SD30855OtherSANFORD HEALTH PLAN
SD57108C020OtherWPS TRICARE
MN372T2HEOtherCC SYSTEMS/ BLUE PLUS
NE46022474352Medicaid
SD7100390Medicaid
SD883880OtherARAZ/ AMERICA'S PPO
SDHP32243OtherHEALTHPARTNERS
IA0522086Medicaid
ND12200Medicaid
MN050827600Medicaid
SD370624200OtherDEPT OF LABOR
SD4570OtherDAKOTACARE
SD7100390Medicaid
SDS41540Medicare PIN
SDG97650Medicare UPIN