Healthcare Provider Details

I. General information

NPI: 1306920152
Provider Name (Legal Business Name): DEANN K PSOTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WEST 33RD STREET
KEARNEY NE
68845
US

IV. Provider business mailing address

211 W 33RD ST
KEARNEY NE
68845-3484
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2141
  • Fax: 308-234-7582
Mailing address:
  • Phone: 308-865-2141
  • Fax: 308-234-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18329
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: