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General NPI Number Information
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NPI Number | 1588032106
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Entity Type | Individual
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Provider Name | JOEL M MPOLESHA PAC
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Gender | Male
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 8303 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68114-4108
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Country | US
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Telephone | 402-354-2360
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Fax | 402-354-2440
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Provider Business Mailing Address
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Address Line | PO BOX 3755
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City | OMAHA
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State | NE
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Zip | 68103-0755
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Country | US
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Telephone | 402-354-2100
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Fax | 402-354-2155
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101576
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8053
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2018019316
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2018019316
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License Number State | MO
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