Provider Demographics
NPI:1366725962
Name:LINEHAN, KATHERINE M (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N 51ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2867
Mailing Address - Country:US
Mailing Address - Phone:402-932-8020
Mailing Address - Fax:402-905-3042
Practice Address - Street 1:119 N 51ST ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2867
Practice Address - Country:US
Practice Address - Phone:402-932-8020
Practice Address - Fax:402-905-3042
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111301363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026301600Medicaid
NE10026480100Medicaid
IA1366725962Medicaid
NE47068731799Medicaid
NE099099130Medicare PIN