Provider Demographics
NPI:1275165730
Name:NELSON, CHRISTA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ANNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S 78TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4543
Mailing Address - Country:US
Mailing Address - Phone:402-238-4215
Mailing Address - Fax:
Practice Address - Street 1:110 N 175TH ST STE 2600
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3515
Practice Address - Country:US
Practice Address - Phone:402-596-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant