Nebraska DHHS: Licensing & Regulatory Affairs: Medical and Specialized Health: Physician Assistant: Name and Address Changes

New Page 2

	Physician Assistant Home Page
	Application Procedures/Requirements
	Applications
	Brochures
	Certification/Verification
	Committee Information
	Complaints
	Contact Information Contact Us
	Continuing Education
	Duplicates/Reissue
	Exam Requirements
	Fees
	License Information System
	Name and Address Change
	Orders - Listings and Labels
	Renewal Information
	Regulations Statutes

Physician Assistant
Name and Address Changes

To request an address change, contact Nicole Carnes-Woutzke at (402) 471-2118 or by e-mail at nicole.carneswoutzke@dhhs.ne.gov To change your name on your Licensure Unit record, you must mail a written request with your notarized signature along with a copy of the legal document verifying name change to:

DHHS, Licensure Unit
Physician Assistants
PO Box 94986
Lincoln NE 68509-4986

Professions and Occupations Home

Licensing & Regulatory Affairs Home

Documents in PDF format require the use of Adobe Acrobat Reader
which can be downloaded for free from Adobe Systems, Inc.

Physician Assistant Name and Address Changes

Physician Assistant
Name and Address Changes