Provider Demographics
NPI:1689479305
Name:MACKE, ERIC JACOB
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JACOB
Last Name:MACKE
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 1:4015 Y ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-2158
Mailing Address - Country:US
Mailing Address - Phone:402-570-8049
Mailing Address - Fax:
Practice Address - Street 1:4433 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4275
Practice Address - Country:US
Practice Address - Phone:402-570-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist