Provider Demographics
NPI:1013574862
Name:DRAGOO, ERIN GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GRACE
Last Name:DRAGOO
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 1:4740 A ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4824
Mailing Address - Country:US
Mailing Address - Phone:402-483-7825
Mailing Address - Fax:402-483-7839
Practice Address - Street 1:2310 WESLEY DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3704
Practice Address - Country:US
Practice Address - Phone:402-202-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant