Provider Demographics
NPI:1801219175
Name:NITZ, LAUREN (MSPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:NITZ
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:WELNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant