Healthcare Provider Details

I. General information

NPI: 1497067581
Provider Name (Legal Business Name): CHRISTINA M LENS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA M FAST PA-C

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 84TH ST
OMAHA NE
68114-4101
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-5400
  • Fax:
Mailing address:
  • Phone: 402-955-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002109
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1540
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: