Individual
MR. RICHARD CHARLES TREADWAY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2201 N BROADWELL AVE, NWIVAHCS, GRAND ISLAND, NE 68803-2153
(308) 382-3660
Mailing address
531 MICKEY ST, PO BOX 135, OSCEOLA, NE 68651-5519
(402) 747-8091
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
131
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131
STATE LICENSE
NE
Enumeration date
09/26/2006
Last updated
07/08/2007
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