Provider Demographics
NPI:1669649646
Name:GOLIBER, NICOLE ALEXIS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXIS
Last Name:GOLIBER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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 1:3685 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5211
Practice Address - Country:US
Practice Address - Phone:402-595-3993
Practice Address - Fax:402-595-1132
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001905363A00000X
NE1361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731749Medicaid
NE47068731797Medicaid
NE47068731741Medicaid
NE10026480100Medicaid
NE47068731734Medicaid
NE47068731741Medicaid