Provider Demographics
NPI:1619927282
Name:TIBBELS, LORETTA R (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:R
Last Name:TIBBELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR STE 145A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1556
Mailing Address - Country:US
Mailing Address - Phone:402-779-7207
Mailing Address - Fax:402-779-7210
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR STE 145A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1556
Practice Address - Country:US
Practice Address - Phone:402-779-7207
Practice Address - Fax:402-779-7210
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE19666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE19666OtherNE LICENSE