Provider Demographics
NPI:1942513866
Name:HEIDTBRINK, MEGAN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:HEIDTBRINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:STRAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 S 70TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-488-3322
Mailing Address - Fax:402-488-1172
Practice Address - Street 1:575 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-488-3322
Practice Address - Fax:402-488-1172
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant