Provider Demographics
NPI:1730257221
Name:INKELAAR, MARIBEL COVARRUBIAS
Entity type:Individual
Prefix:MRS
First Name:MARIBEL
Middle Name:COVARRUBIAS
Last Name:INKELAAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67042
Mailing Address - Street 2:4230 S 33RD STREET STE 103
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-488-2255
Mailing Address - Fax:402-488-2261
Practice Address - Street 1:4230 S 33RD STREET
Practice Address - Street 2:STE 103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-488-2255
Practice Address - Fax:402-488-2261
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76851041C0700X
NE64371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025267800Medicaid