Provider Demographics
NPI:1578579314
Name:CONNORS, ANGELYN M (PAC)
Entity Type:Individual
Prefix:
First Name:ANGELYN
Middle Name:M
Last Name:CONNORS
Suffix:
Gender:F
Credentials:PAC
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 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-5451
Mailing Address - Fax:402-354-5454
Practice Address - Street 1:8111 DODGE ST STE 220
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4117
Practice Address - Country:US
Practice Address - Phone:402-354-1320
Practice Address - Fax:402-354-5965
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025724800Medicaid
NE47068731707Medicaid