1043496243 NPI number — MRS. CHELSIE N. DOANE PA-C

Table of content: MRS. CHELSIE N. DOANE PA-C (NPI 1043496243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043496243 NPI number — MRS. CHELSIE N. DOANE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOANE
Provider First Name:
CHELSIE
Provider Middle Name:
N.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMMERS
Provider Other First Name:
CHELSIE
Provider Other Middle Name:
N.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043496243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7440 S 91ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68526-9797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-489-6555
Provider Business Mailing Address Fax Number:
402-328-3770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3515 RICHMOND CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68803-4965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-381-8636
Provider Business Practice Location Address Fax Number:
308-381-8622
Provider Enumeration Date:
01/17/2008

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: 363A00000X , with the licence number:  1357 , 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: 47070592313 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026072300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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