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Individual

ANDREA KODAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
(402) 559-4017
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
(402) 559-4017

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1043
SC
363A00000X
Physician Assistant
Primary
990
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
990
STATE LICENSE
NE
05
O354PA
SC
Enumeration date
04/28/2006
Last updated
10/23/2012
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