Provider Demographics
NPI:1376084129
Name:LANIK, ABIGAIL L (PAC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:L
Last Name:LANIK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4656
Mailing Address - Country:US
Mailing Address - Phone:402-758-5800
Mailing Address - Fax:402-758-5809
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4656
Practice Address - Country:US
Practice Address - Phone:402-758-5800
Practice Address - Fax:402-758-5809
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant