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NPI Code Detail

MEDICARE: WILLOW STOLL RN, BSN

MEDICARE: WILLOW STOLL RN, BSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse86736NE

General Provider Information

NPI Number : 1306316328
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLOW STOLL RN, BSN
Provider Business Mailing Address
First Line : 4501 PRIMROSE LN
Second Line :
City : BELLEVUE
State : NE
Zip : 68157-2331
Country : US
Telephone Number : 402-310-6867
Fax Number :
Provider Business Practice Location Address
First Line : 1501 THURSTON AVE
Second Line :
City : BELLEVUE
State : NE
Zip : 68123-2498
Country : US
Telephone Number : 402-298-4058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2018
Last Update Date : 12/03/2018

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