Provider Demographics
NPI: | 1396829503 |
---|---|
Name: | SJULIN, ANN MEISSNER (MD) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | ANN |
Middle Name: | MEISSNER |
Last Name: | SJULIN |
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: | 7205 W CENTER RD |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | OMAHA |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68124-2388 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-397-6600 |
Mailing Address - Fax: | 402-397-8318 |
Practice Address - Street 1: | 7205 W CENTER RD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | OMAHA |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68124-2388 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-397-6600 |
Practice Address - Fax: | 402-397-8318 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-24 |
Last Update Date: | 2007-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 18349 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ID | 0904326 | Medicaid | |
NE | 47072606813 | Medicaid | |
NE | 262053 | Medicare ID - Type Unspecified | |
ID | 0904326 | Medicaid | |
NE | 160017960 | Medicare ID - Type Unspecified | RAILROAD MEDICARE |