Provider Demographics
NPI:1659364552
Name:MANDOLFO, NATALIE CHRISTINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:CHRISTINE
Last Name:MANDOLFO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:CHRISTINE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8303 DODGE ST
Mailing Address - Street 2:STE 225
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-354-5860
Mailing Address - Fax:402-354-2350
Practice Address - Street 1:703 RUBY RD
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133
Practice Address - Country:US
Practice Address - Phone:402-505-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE275438364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47062699613Medicaid
P56621Medicare UPIN
NE278512Medicare ID - Type Unspecified