Provider Demographics
NPI:1598804809
Name:FELONEY, SUZANNE D (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:D
Last Name:FELONEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:D
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 NICHOLAS ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2249
Mailing Address - Country:US
Mailing Address - Phone:402-829-6384
Mailing Address - Fax:402-829-6495
Practice Address - Street 1:9900 NICHOLAS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2249
Practice Address - Country:US
Practice Address - Phone:402-829-6384
Practice Address - Fax:402-829-6495
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2084002Medicare PIN