Provider Demographics
NPI:1588939706
Name:ANTONIAK, KARA JEN (APRN)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JEN
Last Name:ANTONIAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:JEN
Other - Last Name:LAIBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1530 S 70TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1567
Mailing Address - Country:US
Mailing Address - Phone:402-327-0073
Mailing Address - Fax:402-327-0204
Practice Address - Street 1:1530 S 70TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1567
Practice Address - Country:US
Practice Address - Phone:402-327-0073
Practice Address - Fax:402-327-0204
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111339363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025812700Medicaid