Provider Demographics
NPI:1154322758
Name:STEFKOVICH, JOHN STEVEN (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:STEFKOVICH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2564
Mailing Address - Country:US
Mailing Address - Phone:402-421-0904
Mailing Address - Fax:402-421-0946
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4282
Practice Address - Country:US
Practice Address - Phone:402-484-4940
Practice Address - Fax:402-484-4941
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE356363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES61527Medicare UPIN
NE271905STMedicare ID - Type Unspecified
970005661Medicare PIN
NE098147040Medicare PIN