Provider Demographics
NPI:1386662278
Name:MOSEMAN, LYNNETTE A (MD)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:A
Last Name:MOSEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14450 EAGLE RUN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1493
Practice Address - Country:US
Practice Address - Phone:402-498-0380
Practice Address - Fax:402-498-0355
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE29499Medicare UPIN
NE273375Medicare ID - Type Unspecified
NE080163346Medicare ID - Type UnspecifiedMEDICARE RR