Provider Demographics
NPI:1366544678
Name:RAABE, MEGAN O BRYAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:O BRYAN
Last Name:RAABE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2331 FAIRFIELD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1348
Mailing Address - Country:US
Mailing Address - Phone:402-434-7177
Mailing Address - Fax:402-434-7180
Practice Address - Street 1:2331 FAIRFIELD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1348
Practice Address - Country:US
Practice Address - Phone:402-434-7177
Practice Address - Fax:402-434-7180
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2014-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE918363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069726000Medicaid
NE47069726017Medicaid