Provider Demographics
NPI:1831128271
Name:GOBBER, MARY K (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:GOBBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE S-109
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2564
Mailing Address - Country:US
Mailing Address - Phone:402-489-0334
Mailing Address - Fax:402-489-0733
Practice Address - Street 1:8055 O ST
Practice Address - Street 2:STE S-109
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2564
Practice Address - Country:US
Practice Address - Phone:402-489-0334
Practice Address - Fax:402-489-0733
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110465363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE252950OtherMIDLANDS CHOICE
NE37710OtherBCBS
280335Medicare PIN