Provider Demographics
NPI:1194952747
Name:RICHMAN, CARMEN DEE (PA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:DEE
Last Name:RICHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-0614
Mailing Address - Country:US
Mailing Address - Phone:308-696-8280
Mailing Address - Fax:308-534-4013
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0614
Practice Address - Country:US
Practice Address - Phone:308-696-8280
Practice Address - Fax:308-534-4013
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00776587OtherRAILROAD MEDICARE PART B PTAN
NE099542002Medicare PIN