Basic Information
| Provider Information | |||||||||
| NPI: | 1659644490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASCHMANN | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | JAE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 S 70TH ST | ||||||||
| Address2: | STE 450 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685063796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024894186 | ||||||||
| FaxNumber: | 4024895279 | ||||||||
| Practice Location | |||||||||
| Address1: | 6911 VAN DORN ST | ||||||||
| Address2: | SUITE # 2 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685066801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024894186 | ||||||||
| FaxNumber: | 4024895279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2012 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 68104 | NE | N | Nursing Service Providers | Registered Nurse | 367500000X | 101199 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.