Provider Demographics
NPI:1801205794
Name:KOLLASCH, DANIELLE MELISSA (MSPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MELISSA
Last Name:KOLLASCH
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 CUTHILLS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526
Mailing Address - Country:US
Mailing Address - Phone:402-476-6060
Mailing Address - Fax:402-476-6809
Practice Address - Street 1:8550 CUTHILLS CIRCLE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526
Practice Address - Country:US
Practice Address - Phone:402-476-6060
Practice Address - Fax:402-476-6809
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2276363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
360101060757896OtherCPHT