Provider Demographics
NPI:1790941763
Name:KISICKI, GLORIA G (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:G
Last Name:KISICKI
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:987740 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-7740
Mailing Address - Country:US
Mailing Address - Phone:402-559-4442
Mailing Address - Fax:402-559-8685
Practice Address - Street 1:987740 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7740
Practice Address - Country:US
Practice Address - Phone:402-559-4442
Practice Address - Fax:402-559-8685
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2009-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE110951363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal