Basic Information
Provider Information | |||||||||
NPI: | 1033204326 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LONOWSKI | ||||||||
FirstName: | ANDREA | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AKSAMIT | ||||||||
OtherFirstName: | ANDREA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7440 S 91ST ST | ||||||||
Address2: |   | ||||||||
City: | LINCOLN | ||||||||
State: | NE | ||||||||
PostalCode: | 685269797 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4024896555 | ||||||||
FaxNumber: | 4023283770 | ||||||||
Practice Location | |||||||||
Address1: | 7440 S 91ST ST | ||||||||
Address2: |   | ||||||||
City: | LINCOLN | ||||||||
State: | NE | ||||||||
PostalCode: | 685269797 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4024896555 | ||||||||
FaxNumber: | 4023283770 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/04/2006 | ||||||||
LastUpdateDate: | 02/01/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 110474 | NE | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 10026072600 | 05 | NE |   | MEDICAID | 47070592305 | 05 | NE |   | MEDICAID | 47070592302 | 05 | NE |   | MEDICAID | 47070592313 | 05 | NE |   | MEDICAID | 47070592300 | 05 | NE |   | MEDICAID | 47070592301 | 05 | NE |   | MEDICAID | 10026072500 | 05 | NE |   | MEDICAID | 47070592306 | 05 | NE |   | MEDICAID |