Basic Information
| Provider Information | |||||||||
| NPI: | 1710055058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 880618 | ||||||||
| Address2: | UNIVERSITY HEALTH CENTER 15TH & U STREETS | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685880618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024725000 | ||||||||
| FaxNumber: | 4024724593 | ||||||||
| Practice Location | |||||||||
| Address1: | 15TH & U STREETS | ||||||||
| Address2: | UNIVERSITY HEALTH CENTER | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685880618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024725000 | ||||||||
| FaxNumber: | 4024724593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | 15118 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10025121400 | 05 | NE | MEDICAID |