Provider Demographics
NPI:1871299826
Name:MACIOLEK, MIA CATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:CATHERINE
Last Name:MACIOLEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 N 46TH ST APT 5307
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3284
Mailing Address - Country:US
Mailing Address - Phone:303-819-1676
Mailing Address - Fax:
Practice Address - Street 1:986845 NEBRASKA MEDICAL CENTER UNIT 5307
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-0001
Practice Address - Country:US
Practice Address - Phone:402-559-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant