Provider Demographics
NPI:1699200972
Name:ELSAESSER, JOHN W (APRN NP-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ELSAESSER
Suffix:
Gender:M
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 FARNAM ST STE 490
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2850
Mailing Address - Country:US
Mailing Address - Phone:402-552-3015
Mailing Address - Fax:402-552-3028
Practice Address - Street 1:4242 FARNAM ST STE 490
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2850
Practice Address - Country:US
Practice Address - Phone:402-552-3015
Practice Address - Fax:402-552-3028
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily