Provider Demographics
NPI:1386819084
Name:LANS, CONNIE E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:E
Last Name:LANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 14TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1215
Mailing Address - Country:US
Mailing Address - Phone:308-995-4431
Mailing Address - Fax:308-995-5912
Practice Address - Street 1:516 W 14TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1215
Practice Address - Country:US
Practice Address - Phone:308-995-4431
Practice Address - Fax:308-995-5912
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant