MEDICARE: MS. ANNA ELIZABETH MENTER PA

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	1468	NE

General Provider Information

NPI Number	:	1942535133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA ELIZABETH MENTER PA

Provider Business Mailing Address
First Line	:	4321 41ST AVE
Second Line	:	PO BOX 1028
City	:	COLUMBUS
State	:	NE
Zip	:	68602-1028
Country	:	US
Telephone Number	:	402-563-9224
Fax Number	:	402-564-0611

Provider Business Practice Location Address
First Line	:	4321 41ST AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1028
Country	:	US
Telephone Number	:	402-563-9224
Fax Number	:	402-564-0611

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	05/27/2015

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