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General NPI Number Information
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NPI Number | 1033885504
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Entity Type | Individual
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Provider Name | SAMANTHA ELLEN PEDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 5200 S 56TH ST STE 2
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City | LINCOLN
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State | NE
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Zip | 68516-1891
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Country | US
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Telephone | 402-421-6200
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Fax | 402-421-6070
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Provider Business Mailing Address
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Address Line | 5200 S 56TH ST STE 2
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City | LINCOLN
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State | NE
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Zip | 68516-1891
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Country | US
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Telephone | 402-421-6200
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Fax | 402-421-6070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2565
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2565
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License Number State | NE
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