Healthcare Provider Details

I. General information

NPI: 1679071724
Provider Name (Legal Business Name): ELISA JEAN ZEISS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 310
GENOA NE
68640-0310
US

IV. Provider business mailing address

219 N 9TH ST
WYMORE NE
68466-1721
US

V. Phone/Fax

Practice location:
  • Phone: 402-993-2283
  • Fax:
Mailing address:
  • Phone: 402-239-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2195
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: