Provider Demographics
NPI:1366601080
Name:CHILDREN'S PHYSICANS @ CREIGHTON PEDIATRICS
Entity type:Organization
Organization Name:CHILDREN'S PHYSICANS @ CREIGHTON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SYNOWIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-280-4580
Mailing Address - Street 1:601 N 30TH ST
Mailing Address - Street 2:SUITE 6820
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2137
Mailing Address - Country:US
Mailing Address - Phone:402-280-4580
Mailing Address - Fax:402-280-4159
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:SUITE 6820
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-280-4580
Practice Address - Fax:402-280-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110229261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEMS1732709OtherFEDERAL DEA # MS1732709