Individual
MELISSA SUE DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4242 FARNAM ST, #650, OMAHA, NE 68131-2806
(402) 559-8600
(402) 559-5010
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1524
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47081304012
NEBRASKA MEDICAID
NE
Enumeration date
06/17/2010
Last updated
09/29/2017
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