Provider Demographics
NPI:1124119482
Name:DENELL, NATHAN P (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:DENELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3201 PIONEERS BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-483-2987
Mailing Address - Fax:402-483-2981
Practice Address - Street 1:3201 PIONEERS BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-483-2987
Practice Address - Fax:402-483-2981
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE50289OtherBCBS
NE47068394113Medicaid
NE47068394113Medicaid