Healthcare Provider Details

I. General information

NPI: 1700865862
Provider Name (Legal Business Name): ROSEMARIE CECELIA TAN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 70TH ST
LINCOLN NE
68510-2462
US

IV. Provider business mailing address

8055 O ST SUITE 300
LINCOLN NE
68510-2564
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-7420
  • Fax:
Mailing address:
  • Phone: 402-421-0904
  • Fax: 402-421-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA052356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: