Provider Demographics
NPI:1649221110
Name:WITT, REBECCA D (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:WITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 OLD CHENEY RD
Mailing Address - Street 2:#101-331
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5901
Mailing Address - Country:US
Mailing Address - Phone:402-758-5800
Mailing Address - Fax:402-758-5809
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ
Practice Address - Street 2:#102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5800
Practice Address - Fax:402-758-5809
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39024OtherBLUE CROSS BLUE SHIELD
NEP79950Medicare UPIN
NE276304Medicare ID - Type Unspecified
NE281142Medicare PIN