MEDICARE: MRS. JULIE MARIE WIEKAMP PA

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
1	363A00000X	Physician Assistant	1234	NE

General Provider Information

NPI Number	:	1568412641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE MARIE WIEKAMP PA

Provider Business Mailing Address
First Line	:	3540 VILLAGE DR STE 100
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4706
Country	:	US
Telephone Number	:	402-420-7113
Fax Number	:	402-328-8314

Provider Business Practice Location Address
First Line	:	3540 VILLAGE DR STE 100
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4706
Country	:	US
Telephone Number	:	402-420-7113
Fax Number	:	402-328-8314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/18/2020

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