Provider Demographics
NPI:1245983840
Name:QUICHOCHO, KATIE C (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:QUICHOCHO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:C
Other - Last Name:ODVODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:16945 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2312
Mailing Address - Country:US
Mailing Address - Phone:402-397-7400
Mailing Address - Fax:402-397-0115
Practice Address - Street 1:16945 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2312
Practice Address - Country:US
Practice Address - Phone:402-397-7400
Practice Address - Fax:402-397-0115
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2705363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant