Provider Demographics
NPI:1699580845
Name:LIBOLT, VICKI M
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:M
Last Name:LIBOLT
Suffix:
Gender:F
Credentials:
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 268
Mailing Address - Street 2:
Mailing Address - City:CHAMBERS
Mailing Address - State:NE
Mailing Address - Zip Code:68725-0268
Mailing Address - Country:US
Mailing Address - Phone:402-482-5299
Mailing Address - Fax:
Practice Address - Street 1:404 S C ST
Practice Address - Street 2:
Practice Address - City:CHAMBERS
Practice Address - State:NE
Practice Address - Zip Code:68725-5006
Practice Address - Country:US
Practice Address - Phone:402-482-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant