Provider Demographics
NPI:1962456111
Name:GREISEN, SARA JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:GREISEN
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 1:6262 S. 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-540-5840
Mailing Address - Fax:402-423-4201
Practice Address - Street 1:5566 S. 56TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-423-6510
Practice Address - Fax:401-216-4295
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE23160OtherBCBS
NE23160OtherBCBS
Q37880Medicare UPIN
NE099827001Medicare PIN