Provider Demographics
NPI:1275166126
Name:ROSENTHAL, ALEXEI BOETTCHER (APRN-NP)
Entity Type:Individual
Prefix:
First Name:ALEXEI
Middle Name:BOETTCHER
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20711 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2665
Mailing Address - Country:US
Mailing Address - Phone:402-910-3593
Mailing Address - Fax:
Practice Address - Street 1:312 OLSON DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2978
Practice Address - Country:US
Practice Address - Phone:402-933-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA162560363L00000X
NE113061363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily