Provider Demographics
NPI:1235602533
Name:HALL, ANN ELIZABETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:DEN HARTOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2043 N 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4331
Mailing Address - Country:US
Mailing Address - Phone:402-707-2506
Mailing Address - Fax:
Practice Address - Street 1:7500 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9772
Practice Address - Country:US
Practice Address - Phone:402-327-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical