Provider Demographics
NPI:1780821819
Name:HEIBEL, NICOLE M (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HEIBEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 PINEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6519
Mailing Address - Country:US
Mailing Address - Phone:402-217-2707
Mailing Address - Fax:
Practice Address - Street 1:1940 PINEDALE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6519
Practice Address - Country:US
Practice Address - Phone:402-217-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist