Provider Demographics
NPI:1679674436
Name:HURT, NICHOLE (PLMHP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 'O' STREET
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-488-1032
Mailing Address - Fax:402-488-8545
Practice Address - Street 1:8101 'O' STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-488-1032
Practice Address - Fax:402-488-8545
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025379600Medicaid