Basic Information
| Provider Information | |||||||||
| NPI: | 1295813640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBB | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 DORWART DR | ||||||||
| Address2: | PO BOX 379 | ||||||||
| City: | SIDNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691622505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082545544 | ||||||||
| FaxNumber: | 3082542672 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 DORWART DR | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691622505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082545544 | ||||||||
| FaxNumber: | 3082542672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/02/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 714 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970003618 | 01 | NE | RAILROAD MEDICARE | OTHER |