Individual
CONNIE L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
105 N 31ST AVE, STE 102, OMAHA, NE 68131-2940
(402) 346-1111
(402) 408-0004
Mailing address
105 N 31ST AVE, STE 102, OMAHA, NE 68131-2940
(402) 346-1111
(402) 408-0004
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
640
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37956
BCBS
NE
01
—
810
MIDLANDS
NE
01
—
970015303
RAILROAD MEDICARE
—
Enumeration date
08/02/2006
Last updated
04/19/2012
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