Provider Demographics
NPI:1942921168
Name:DUBOV, VERONIKA DANIELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:VERONIKA
Middle Name:DANIELLE
Last Name:DUBOV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N 173RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2641
Mailing Address - Country:US
Mailing Address - Phone:402-708-0115
Mailing Address - Fax:
Practice Address - Street 1:6829 N 72ND ST STE 3100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1724
Practice Address - Country:US
Practice Address - Phone:402-572-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117739363A00000X
390200000X
NE2862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program