Provider Demographics
NPI:1508085929
Name:PROBASCO, AIMEE M (DO)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:M
Last Name:PROBASCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:11946 STANDING STONE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-8094
Practice Address - Country:US
Practice Address - Phone:402-815-4500
Practice Address - Fax:402-815-4510
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5512207VH0002X
NE1245207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026480100Medicaid
IA1508085929Medicaid
NE47068731799Medicaid
NE10026301600Medicaid
NE10026480100Medicaid