Provider Demographics
NPI:1518644210
Name:ONDRAK, MADELINE CLAIRE (PA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:CLAIRE
Last Name:ONDRAK
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 1:2511 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4624
Mailing Address - Country:US
Mailing Address - Phone:970-646-8608
Mailing Address - Fax:
Practice Address - Street 1:2115 N KANSAS AVE # 105
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2640
Practice Address - Country:US
Practice Address - Phone:402-463-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant