Provider Demographics
NPI:1609851005
Name:YRASTORZA, TIMOTHY J (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:YRASTORZA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 A ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4824
Mailing Address - Country:US
Mailing Address - Phone:402-483-7825
Mailing Address - Fax:402-483-7839
Practice Address - Street 1:4740 A ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4824
Practice Address - Country:US
Practice Address - Phone:402-483-7825
Practice Address - Fax:402-483-7839
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE966363AS0400X
NE1213363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47059807113Medicaid
NEQ51156Medicare UPIN