Provider Demographics
NPI:1649646605
Name:CEBULA, MIRANDA L (PA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:CEBULA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 N LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1072
Mailing Address - Country:US
Mailing Address - Phone:402-362-5555
Mailing Address - Fax:402-362-7137
Practice Address - Street 1:2114 N LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1072
Practice Address - Country:US
Practice Address - Phone:402-362-5555
Practice Address - Fax:402-362-7137
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST-04346OtherLICENSE