Provider Demographics
NPI:1093835852
Name:BOHLEN, SUZANE LYNNE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUZANE
Middle Name:LYNNE
Last Name:BOHLEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SUZANE
Other - Middle Name:LYNNE
Other - Last Name:LIVASY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34310
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134
Mailing Address - Country:US
Mailing Address - Phone:402-778-9738
Mailing Address - Fax:402-334-2849
Practice Address - Street 1:6901 N 72 ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-778-9738
Practice Address - Fax:402-334-2849
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE901697367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21224OtherMEDICARE-MERCY
NE10025745800Medicaid
NE47055043815Medicaid
NE10025709800Medicaid
NE098713OtherMEDICARE-IMC/BERGAN
IA10025507900Medicaid
NENA1324OtherMEDICARE-MIDLANDS