Provider Demographics
NPI:1619060225
Name:WEST NEBRASKA NEURO-DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:WEST NEBRASKA NEURO-DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHANAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-1198
Mailing Address - Street 1:TWO WEST 42ND ST
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361
Mailing Address - Country:US
Mailing Address - Phone:308-630-1198
Mailing Address - Fax:308-630-1657
Practice Address - Street 1:TWO WEST 42ND ST
Practice Address - Street 2:SUITE 3500
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-630-1198
Practice Address - Fax:308-630-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherFEDERAL ID#