1093835852 NPI number — SUZANE LYNNE BOHLEN CRNA

Table of content: DR. LU YAO MD (NPI 1396794590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093835852 NPI number — SUZANE LYNNE BOHLEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHLEN
Provider First Name:
SUZANE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIVASY
Provider Other First Name:
SUZANE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093835852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-778-9738
Provider Business Mailing Address Fax Number:
402-334-2849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6901 N 72 ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-778-9738
Provider Business Practice Location Address Fax Number:
402-334-2849
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  901697 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: I21224 . This is a "MEDICARE-MERCY" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 10025745800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47055043815 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025709800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 098713 . This is a "MEDICARE-IMC/BERGAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025507900 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA1324 . This is a "MEDICARE-MIDLANDS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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