Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 101Y00000X | Counselor | | | | No |
| 2 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 3 | 103T00000X | Psychologist | | | | No |
| 4 | 133NN1002X | Nutritionist | Nutrition, Education | | | No |
| 5 | 207P00000X | Emergency Medicine | | | | Yes |
| 6 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 7 | 207RG0300X | Internal Medicine | Geriatric Medicine | | | No |
| 8 | 207RP1001X | Internal Medicine | Pulmonary Disease | | | No |
| 9 | 207V00000X | Obstetrics & Gynecology | | | | No |
| 10 | 207ZP0102X | Pathology | Anatomic Pathology & Clinical Pathology | | | No |
| 11 | 2080N0001X | Pediatrics | Neonatal-Perinatal Medicine | | | No |
| 12 | 208100000X | Physical Medicine & Rehabilitation | | | | No |
| 13 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 14 | 363A00000X | Physician Assistant | | | | No |
| 15 | 363L00000X | Nurse Practitioner | | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1832 | OTHER | NEBRASKA | BCBS GEM CLINIC |
| 2 | 1959 | OTHER | NEBRASKA | BCBS ER & BEHAVIORAL |
| 3 | 7715 | OTHER | NEBRASKA | BCBS SLEEP LAB |
| 4 | 00334 | OTHER | NEBRASKA | BCBS HOME HEALTH |
| 5 | 2854 | OTHER | NEBRASKA | BCBS NEUROPSYCHOLOGY |
| 6 | 1859 | OTHER | NEBRASKA | BCBS DIAGNOSTICS |
| 7 | 7758 | OTHER | NEBRASKA | BCBS PHYSICAL MED & REHAB |
| 8 | 1966 | OTHER | NEBRASKA | BCBS PERINATE/REPRO ENDO |
| 9 | 81001 | OTHER | NEBRASKA | BCBS DIABETES |
| 10 | 6000044 | OTHER | NEBRASKA | UHC HOME HEALTH |
| 11 | 2977 | OTHER | NEBRASKA | BCBS PATHOLOGY |
| 12 | 7750 | OTHER | NEBRASKA | BCBS CARDIOLOGY |
