Healthcare Provider Details

I. General information

NPI: 1013446913
Provider Name (Legal Business Name): NATASHA NICOLE ANDERSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N 27TH ST STE 101
LINCOLN NE
68521-4752
US

IV. Provider business mailing address

5901 N 27TH ST STE 101
LINCOLN NE
68521-4752
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2138
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2138
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: