Provider Demographics
NPI:1548438880
Name:JONSSON RAZDAN, PETRA SUSANNA (MD)
Entity type:Individual
Prefix:DR
First Name:PETRA
Middle Name:SUSANNA
Last Name:JONSSON RAZDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PETRA
Other - Middle Name:SUSANNA
Other - Last Name:RAZDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:600 N COTNER BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-464-5969
Mailing Address - Fax:402-464-3657
Practice Address - Street 1:600 N COTNER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505
Practice Address - Country:US
Practice Address - Phone:402-464-5969
Practice Address - Fax:402-464-3657
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000000000000000000207R00000X
NE44972207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060801513Medicaid