Healthcare Provider Details

I. General information

NPI: 1184334195
Provider Name (Legal Business Name): AUSTIN ENFIELD P-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8248 S 96TH ST
LA VISTA NE
68128-3126
US

IV. Provider business mailing address

12058 IVA ST
GRETNA NE
68028-4656
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2858
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: