Provider Demographics
NPI:1487665808
Name:CREAL, SUSAN D (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:CREAL
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:PO BOX 81406
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68501
Mailing Address - Country:US
Mailing Address - Phone:800-678-7672
Mailing Address - Fax:
Practice Address - Street 1:1600 SOUTH 48TH STREET
Practice Address - Street 2:ER DEPT
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-489-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE301000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37852OtherBCBS
NE37852OtherBCBS
S48779Medicare UPIN
970005460Medicare PIN
NE270367Medicare PIN