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General NPI Number Information
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NPI Number | 1871299826
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Entity Type | Individual
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Provider Name | MIA CATHERINE STOLTENBERG PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 17201 WRIGHT ST STE 200
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City | OMAHA
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State | NE
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Zip | 68130-2042
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Country | US
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Telephone | 402-334-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 10416 S 112TH ST
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City | PAPILLION
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State | NE
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Zip | 68046-5570
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Country | US
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Telephone | 303-819-1676
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Fax |
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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 | 2879
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License Number State | NE
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