Provider Demographics
NPI:1245299304
Name:KROBOT, KRISTIN NICOLE (PAC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:KROBOT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:N
Other - Last Name:KIRKWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6901 N. 72ND ST.
Mailing Address - Street 2:IMMANUEL EMERGENCY ROOM
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122
Mailing Address - Country:US
Mailing Address - Phone:402-572-2225
Mailing Address - Fax:402-572-2987
Practice Address - Street 1:6901 N. 72ND ST.
Practice Address - Street 2:IMMANUEL EMERGENCY ROOM
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-572-2225
Practice Address - Fax:402-572-2987
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00354683OtherPALMETTO - GBA
NE279909Medicare PIN