Provider Demographics
NPI:1962209874
Name:MALKO, NIDEMA
Entity type:Individual
Prefix:
First Name:NIDEMA
Middle Name:
Last Name:MALKO
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 1:1310 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-2462
Mailing Address - Country:US
Mailing Address - Phone:402-570-7767
Mailing Address - Fax:
Practice Address - Street 1:1310 PATTERSON DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-2462
Practice Address - Country:US
Practice Address - Phone:402-570-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant