Provider Demographics
NPI:1578584280
Name:CRANE, PETER A (PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:CRANE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 S 73RD PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-1507
Mailing Address - Country:US
Mailing Address - Phone:402-991-9060
Mailing Address - Fax:402-991-9060
Practice Address - Street 1:8419 S 73RD PLZ STE 101
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-991-9060
Practice Address - Fax:402-991-9060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE611207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE558094Medicare UPIN
NE269303Medicare ID - Type UnspecifiedMEDICARE