=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144210402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN M TONKIN PAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2005
-----------------------------------------------------
Last Update Date | 03/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4101 TIGER LILY RD STE 100
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68516-5587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-420-7000
-----------------------------------------------------
Fax | 402-420-6969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4101 TIGER LILY RD STE 100
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68516-5587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-420-7000
-----------------------------------------------------
Fax | 402-420-6969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 944
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------