Healthcare Provider Details

I. General information

NPI: 1104165620
Provider Name (Legal Business Name): NISHANTHIKA NAVARATNARAJAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA STREET
NORTH PLATTE NE
69103
US

IV. Provider business mailing address

601 W LEOTA STREET PO BOX 1167
NORTH PLATTE NE
69103-1167
US

V. Phone/Fax

Practice location:
  • Phone: 308-568-8000
  • Fax: 308-568-8769
Mailing address:
  • Phone: 308-568-8000
  • Fax: 308-568-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28665
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: