Provider Demographics
NPI:1871596601
Name:NEBELUNG, DON (PA-C)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:NEBELUNG
Suffix:
Gender:M
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 1:609 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1564
Mailing Address - Country:US
Mailing Address - Phone:785-632-2181
Mailing Address - Fax:785-632-2309
Practice Address - Street 1:609 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1564
Practice Address - Country:US
Practice Address - Phone:785-632-2181
Practice Address - Fax:785-632-2309
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS035313OtherMEDICARE
KS200006390AMedicaid
KS200006390AMedicaid