Healthcare Provider Details

I. General information

NPI: 1801150511
Provider Name (Legal Business Name): ANTHONY ROBERT MANN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 192ND ST
ELKHORN NE
68022-5363
US

IV. Provider business mailing address

8005 FARNAM DR STE 305
OMAHA NE
68114-3426
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-4111
  • Fax: 402-390-4115
Mailing address:
  • Phone: 402-390-4111
  • Fax: 402-390-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1665
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: