Individual
STEFANIE A BREITKREUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
EMILE 42ND ST, OMAHA, NE 68198-1928
(402) 559-4015
(402) 559-8715
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01093
KS
363A00000X
Physician Assistant
Primary
2119
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200376510A
—
KS
01
—
426969
BLUE CROSS BLUE SHIELD
KS
Enumeration date
09/04/2006
Last updated
06/13/2017
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