Provider Demographics
NPI:1295813640
Name:ROBB, ANGELA T (PAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:T
Last Name:ROBB
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 DORWART DR
Mailing Address - Street 2:PO BOX 379
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2505
Mailing Address - Country:US
Mailing Address - Phone:308-254-5544
Mailing Address - Fax:308-254-2672
Practice Address - Street 1:1625 DORWART DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2505
Practice Address - Country:US
Practice Address - Phone:308-254-5544
Practice Address - Fax:308-254-2672
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE970003618OtherRAILROAD MEDICARE
NE268336Medicare PIN
NE970003618OtherRAILROAD MEDICARE