Provider Demographics
NPI:1376568444
Name:LENNEMANN, PAUL J (ATP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:LENNEMANN
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2939
Mailing Address - Country:US
Mailing Address - Phone:402-342-4901
Mailing Address - Fax:402-342-4946
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:SUITE 121
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-342-4901
Practice Address - Fax:402-342-4946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025343300Medicaid
NE10025343300Medicaid