Provider Demographics
NPI:1447316757
Name:KATHERINEZUPANCICMACPCLPCPC
Entity type:Organization
Organization Name:KATHERINEZUPANCICMACPCLPCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:SANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RETIRED RN
Authorized Official - Phone:402-476-3002
Mailing Address - Street 1:301 S 13TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2537
Mailing Address - Country:US
Mailing Address - Phone:402-476-3002
Mailing Address - Fax:402-476-3002
Practice Address - Street 1:301 S 13TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2537
Practice Address - Country:US
Practice Address - Phone:402-476-3002
Practice Address - Fax:402-476-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE301 & 397261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84413OtherBCBS
NEMHS093572OtherVALUE OPTIONS
NEMHS093572OtherVALUE OPTIONS
NE========= & 52266116OtherMIDLANDS CHOICE
NE84413OtherBCBS