Provider Demographics
NPI:1285218230
Name:GUY, ELLEREE DEE (PA)
Entity Type:Individual
Prefix:
First Name:ELLEREE
Middle Name:DEE
Last Name:GUY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 16TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3762
Mailing Address - Country:US
Mailing Address - Phone:402-488-3002
Mailing Address - Fax:402-483-8787
Practice Address - Street 1:2222 S 16TH ST STE 305
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3762
Practice Address - Country:US
Practice Address - Phone:402-488-3002
Practice Address - Fax:402-483-8787
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113963363A00000X
NE2964363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant