Provider Demographics
NPI:1457323479
Name:ROTTINGHAUS, ELISA A (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:A
Last Name:ROTTINGHAUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 STONE ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2660
Mailing Address - Country:US
Mailing Address - Phone:402-245-3232
Mailing Address - Fax:402-245-4022
Practice Address - Street 1:1423 STONE ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2660
Practice Address - Country:US
Practice Address - Phone:402-245-3232
Practice Address - Fax:402-245-4022
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15 00666363A00000X
NE1693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100066950DMedicaid
NE1693OtherSTATE LICENSE
P21212Medicare UPIN