MEDICARE: ANGELIKA L STEVENS PAC

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	363AM0700X	Medical Physician Assistant	936	NE

General Provider Information

NPI Number	:	1568420891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIKA L STEVENS PAC

Provider Business Mailing Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 202
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-758-5240
Fax Number	:	402-758-5792

Provider Business Practice Location Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 202
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-758-5240
Fax Number	:	402-758-5792

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/05/2015

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Directions to “ ANGELIKA L STEVENS PAC” Practice Location

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