Healthcare Provider Details

I. General information

NPI: 1144610197
Provider Name (Legal Business Name): ERIN DORN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 HOSPITAL PKWY
BEATRICE NE
68310-6906
US

IV. Provider business mailing address

4800 HOSPITAL PKWY
BEATRICE NE
68310-6906
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-6761
  • Fax: 402-223-6565
Mailing address:
  • Phone: 402-223-6761
  • Fax: 402-223-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1882
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: