Healthcare Provider Details

I. General information

NPI: 1801571880
Provider Name (Legal Business Name): COLE A NEVILLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD STE 224
OMAHA NE
68124-2346
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-0070
  • Fax: 402-717-0073
Mailing address:
  • Phone: 402-717-0770
  • Fax: 402-717-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2944
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: