Healthcare Provider Details

I. General information

NPI: 1033956321
Provider Name (Legal Business Name): KAYLA ROSENTHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 A ST STE 300
LINCOLN NE
68510-4970
US

IV. Provider business mailing address

5055 A ST STE 300
LINCOLN NE
68510-4970
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3369
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: