Provider Demographics
NPI:1508198672
Name:NICE, BRIAN BARRY (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:BARRY
Last Name:NICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N 112TH CT
Mailing Address - Street 2:APT. # 6303
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5896
Mailing Address - Country:US
Mailing Address - Phone:402-250-4050
Mailing Address - Fax:
Practice Address - Street 1:987424 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7424
Practice Address - Country:US
Practice Address - Phone:402-552-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1486363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical