Healthcare Provider Details

I. General information

NPI: 1982687927
Provider Name (Legal Business Name): NICOLE DAWN PFEIL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 NORTH KANSAS AVENUE CHILDREN & ADOLESCENT CLINIC PC
HASTINGS NE
68901
US

IV. Provider business mailing address

2115 N KANSAS AVE STE 103
HASTINGS NE
68901-2615
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-6828
  • Fax: 402-463-4767
Mailing address:
  • Phone: 402-463-6828
  • Fax: 402-463-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1002
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: