NUlirt | User Account Request

ANY QUESTIONS OR CONCERNS, YOU MAY CONTACT CLIENT SERVICES AT 402-559-2440 OR TOLL FREE AT 866-290-1406.

First Name *

First Name is required.

Middle Initial

Last Name *

Last Name is required.

NPI

Enter NPI if possessed.

Email *

A valid email is required.

Phone Number *

A 10-digit phone number is required.

Password *

Must be 15 characters, 1 upper, 1 lower, 1 num, 1 special.

Confirm Password *

Passwords do not match.

Client Name / Account Number *

Client Name / Account Number is required.

Date *

A valid date is required.

I am responsible for the confidentiality of my user name and password. I acknowledge that disclosure to any other person is unauthorized and I am aware this information is to be kept confidential and any violation of this policy will also be subject to disciplinary action, as outlined in the UNMC Policy for Responsible Use of University Computers and Information Systems.

Signature *