Basic Information
| Provider Information | |||||||||
| NPI: | 1609374925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSS | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 S 17TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838555 | ||||||||
| FaxNumber: | 4024838554 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 S 17TH ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838555 | ||||||||
| FaxNumber: | 4024838554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2018 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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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 | 363AM0700X | 2193 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.