Provider Demographics
NPI:1720887219
Name:LIBRA, PAMELA SUE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:LIBRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E HUGHSON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NE
Mailing Address - Zip Code:68771-5305
Mailing Address - Country:US
Mailing Address - Phone:402-350-7691
Mailing Address - Fax:
Practice Address - Street 1:84816 559TH AVE
Practice Address - Street 2:
Practice Address - City:HOSKINS
Practice Address - State:NE
Practice Address - Zip Code:68740-4060
Practice Address - Country:US
Practice Address - Phone:402-860-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant