MEDICARE: MRS. MENDY MARIE PETERSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1874	NE

General Provider Information

NPI Number	:	1205834173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MENDY MARIE PETERSON PA-C

Provider Business Mailing Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 102
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-758-5800
Fax Number	:	402-758-5809

Provider Business Practice Location Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 102
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-758-5800
Fax Number	:	402-758-5809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/25/2016

Similar Medicare Providers

1518959295 — DR. BONNIE JEAN LEES MD
Practice Location Address:

8200 DODGE STREET , CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA, NE
68114-4113

Practice Phone: 402-955-6140
Practice Fax: 402-955-3398

1568420891 — ANGELIKA L STEVENS PAC
Practice Location Address:

17030 LAKESIDE HILLS PLZ , SUITE 202
OMAHA, NE
68130-2396

Practice Phone: 402-758-5240
Practice Fax: 402-758-5792

1649221110 — REBECCA D WITT PA-C
Practice Location Address:

17030 LAKESIDE HILLS PLZ , #102
OMAHA, NE
68130-2396

Practice Phone: 402-758-5800
Practice Fax: 402-758-5809

1417995192 — ANN EDMUNDS MD
Practice Location Address:

17030 LAKESIDE HILLS PLZ , SUITE 204
OMAHA, NE
68130-2396

Practice Phone: 402-758-5600
Practice Fax: 402-758-5169

1225071681 — JAMES V HUERTER JR. MD
Practice Location Address:

17030 LAKESIDE HILLS PLZ , SUITE 204
OMAHA, NE
68130-2396

Practice Phone: 402-758-5600
Practice Fax: 402-758-5169

1881623569 — FREDERIC P OGREN MD
Practice Location Address:

17030 LAKESIDE HILLS PLZ , SUITE 204
OMAHA, NE
68130-2396

Practice Phone: 402-758-5600
Practice Fax: 402-758-5169

Directions to “ MRS. MENDY MARIE PETERSON PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.