Basic Information
| Provider Information | |||||||||
| NPI: | 1508085929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROBASCO | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3755 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681030755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023542100 | ||||||||
| FaxNumber: | 4023542155 | ||||||||
| Practice Location | |||||||||
| Address1: | 11946 STANDING STONE DR | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680288094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028154500 | ||||||||
| FaxNumber: | 4028154510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VH0002X | 5512 | NE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Hospice and Palliative Medicine | 207V00000X | 1245 | NE | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 10026480100 | 05 | NE | MEDICAID | 1508085929 | 05 | IA | MEDICAID | 47068731799 | 05 | NE | MEDICAID | 10026301600 | 05 | NE | MEDICAID |