Provider Demographics
NPI:1437113271
Name:MOLINE, SUSAN R (PA C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:MOLINE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:4600 VALLEY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4844
Mailing Address - Country:US
Mailing Address - Phone:402-483-4571
Mailing Address - Fax:402-483-5079
Practice Address - Street 1:4600 VALLEY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4844
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:402-483-5079
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE88207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301100Medicaid
NE47055301100Medicaid
S61553Medicare UPIN