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NPI Code Detail

MEDICARE: MRS. NICOLE DAWN PFEIL PAC

MEDICARE: MRS. NICOLE DAWN PFEIL 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
1363A00000XPhysician Assistant1002NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
202885OTHERNEBCBS

General Provider Information

NPI Number : 1982687927
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE DAWN PFEIL PAC
Provider Business Mailing Address
First Line : 2115 N KANSAS AVE STE 103
Second Line :
City : HASTINGS
State : NE
Zip : 68901-2615
Country : US
Telephone Number : 402-463-6828
Fax Number : 402-463-4767
Provider Business Practice Location Address
First Line : 2115 NORTH KANSAS AVENUE
Second Line : CHILDREN & ADOLESCENT CLINIC PC
City : HASTINGS
State : NE
Zip : 68901
Country : US
Telephone Number : 402-463-6828
Fax Number : 402-463-4767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 11/22/2019

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Directions to “ MRS. NICOLE DAWN PFEIL PAC” Practice Location

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