Provider Demographics
NPI:1316168628
Name:MENTZER, GINA GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:GRACE
Last Name:MENTZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:GRACE
Other - Last Name:WARDYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:2000 Q ST
Practice Address - Street 2:SUITE 500
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3609
Practice Address - Country:US
Practice Address - Phone:402-328-4572
Practice Address - Fax:402-421-0946
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27190207RC0000X
OH35.095058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072500Medicaid
NE10026072000Medicaid
NE10026072600Medicaid
NE10026072300Medicaid
NE10026072200Medicaid
NE10026072400Medicaid
NE10026072400Medicaid
NE10026072400Medicaid