Provider Demographics
NPI:1790461440
Name:SWARTZENDRUBER, NICOLE LEE (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:SWARTZENDRUBER
Suffix:
Gender:
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 1:806 ROAD W
Mailing Address - Street 2:
Mailing Address - City:SHICKLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68436-3038
Mailing Address - Country:US
Mailing Address - Phone:402-759-6202
Mailing Address - Fax:
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:402-362-6328
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE3235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program