Provider Demographics
NPI:1447438353
Name:MORAN MANZITTO, ANGELA K (PA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:MORAN MANZITTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2564
Mailing Address - Country:US
Mailing Address - Phone:402-421-0904
Mailing Address - Fax:402-421-0946
Practice Address - Street 1:2200 S 40TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2425
Practice Address - Country:US
Practice Address - Phone:402-483-6000
Practice Address - Fax:402-483-6106
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1371363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE092294003Medicare PIN
P00664410Medicare PIN
P00657923Medicare PIN
NE098147008Medicare PIN