Provider Demographics
NPI:1194733709
Name:NOECKER, TANJA L (PA-C)
Entity type:Individual
Prefix:
First Name:TANJA
Middle Name:L
Last Name:NOECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANJA
Other - Middle Name:L
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:4501 S 70TH ST
Practice Address - Street 2:STE 130
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4282
Practice Address - Country:US
Practice Address - Phone:402-484-4940
Practice Address - Fax:402-484-4941
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1209363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE248145OtherMIDLAND'S CHOICE
NE37837OtherBCBS - LINC CARE
NE37836OtherBCBS - ELIM
279471Medicare PIN
279472Medicare PIN
P00266077Medicare PIN
Q54035Medicare UPIN
NE37837OtherBCBS - LINC CARE