Provider Demographics
NPI:1962181776
Name:LOBO PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:LOBO PSYCHIATRIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC, FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:619-993-6004
Mailing Address - Street 1:6255 SW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NE
Mailing Address - Zip Code:68339-3375
Mailing Address - Country:US
Mailing Address - Phone:619-993-6004
Mailing Address - Fax:
Practice Address - Street 1:5539 S 27TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1600
Practice Address - Country:US
Practice Address - Phone:402-261-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty