Provider Demographics
NPI:1194128058
Name:EMANUEL, ELLEN (LAC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N 8TH ST
Mailing Address - Street 2:306
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1350
Mailing Address - Country:US
Mailing Address - Phone:303-916-0911
Mailing Address - Fax:
Practice Address - Street 1:4747 PIONEERS BLVD
Practice Address - Street 2:SUITE 700B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5313
Practice Address - Country:US
Practice Address - Phone:402-937-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist