Individual
MISS LEANNE RENEE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1710 S 70TH ST, LINCOLN, NE 68506-1676
(402) 484-9009
(402) 483-4223
Mailing address
PO BOX 6068, LINCOLN, NE 68506-0068
(402) 484-9009
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1302
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47065843713
—
NE
Enumeration date
02/28/2007
Last updated
10/28/2011
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