Provider Demographics
NPI:1497067581
Name:LENS, CHRISTINA M (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:LENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:FAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8200 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-3871
Mailing Address - Fax:
Practice Address - Street 1:111 N 84TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4101
Practice Address - Country:US
Practice Address - Phone:402-955-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002109363A00000X
NE1540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1497067581Medicaid
NE099099161Medicare PIN
NE10026301600Medicaid
NE47068731799Medicaid
NE47068731799Medicaid