Provider Demographics
NPI:1427062538
Name:BELITZ, JENNY S (PA-C)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:S
Last Name:BELITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11724
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4008
Mailing Address - Country:US
Mailing Address - Phone:402-721-7077
Mailing Address - Fax:402-753-6056
Practice Address - Street 1:350 W 23RD ST
Practice Address - Street 2:STE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2592
Practice Address - Country:US
Practice Address - Phone:402-721-7077
Practice Address - Fax:402-753-6056
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE384363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37825OtherBCBS
P00243532OtherRR MEDICARE
NE10025238700Medicaid
NE37825OtherBCBS
278760Medicare PIN
P00243532OtherRR MEDICARE