Provider Demographics
NPI:1619083383
Name:SPRINGER, MATTHEW THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 AARON CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-9491
Mailing Address - Country:US
Mailing Address - Phone:402-423-7774
Mailing Address - Fax:402-423-7774
Practice Address - Street 1:625 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2404
Practice Address - Country:US
Practice Address - Phone:402-423-7774
Practice Address - Fax:402-423-7774
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100776367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025092100Medicaid
NE10025092100Medicaid