Provider Demographics
NPI:1982687927
Name:PFEIL, NICOLE DAWN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DAWN
Last Name:PFEIL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2115 N KANSAS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2615
Mailing Address - Country:US
Mailing Address - Phone:402-463-6828
Mailing Address - Fax:402-463-4767
Practice Address - Street 1:2115 NORTH KANSAS AVENUE
Practice Address - Street 2:CHILDREN & ADOLESCENT CLINIC PC
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-463-6828
Practice Address - Fax:402-463-4767
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063717813Medicaid
NE02885OtherBCBS