Provider Demographics
NPI:1689096794
Name:THURBER, RANDOLPH (CSW)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:THURBER
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 Q ST
Mailing Address - Street 2:STE 111
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3539
Mailing Address - Country:US
Mailing Address - Phone:402-890-5531
Mailing Address - Fax:
Practice Address - Street 1:2501 Q ST
Practice Address - Street 2:STE 111
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3539
Practice Address - Country:US
Practice Address - Phone:402-890-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025513400Medicaid