MEDICARE: ADREANNA EILEEN ERNEST

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	3074	NE

General Provider Information

NPI Number	:	1467186502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADREANNA EILEEN ERNEST

Provider Business Mailing Address
First Line	:	988102 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-8102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 FARNAM ST APT 2519
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-3516
Country	:	US
Telephone Number	:	308-279-2421
Fax Number	:

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

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	02/06/2024

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