Provider Demographics
NPI:1588338115
Name:NETZ, NICOLETTE TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:TAYLOR
Last Name:NETZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6068
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0068
Mailing Address - Country:US
Mailing Address - Phone:402-484-9009
Mailing Address - Fax:402-483-4223
Practice Address - Street 1:7100 STEPHANIE LN
Practice Address - Street 2:STE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5332
Practice Address - Country:US
Practice Address - Phone:402-484-9009
Practice Address - Fax:402-483-4223
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2625207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026398802Medicaid