Provider Demographics
NPI:1194731869
Name:ANTLEY, MARGARET ALICE (PA - C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ALICE
Last Name:ANTLEY
Suffix:
Gender:F
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 1:9610 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-2369
Mailing Address - Country:US
Mailing Address - Phone:402-731-8228
Mailing Address - Fax:
Practice Address - Street 1:710 S 17TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-3108
Practice Address - Country:US
Practice Address - Phone:402-599-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1076363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical