Healthcare Provider Details

I. General information

NPI: 1831703362
Provider Name (Legal Business Name): KELLI LEIGH KUHLENENGEL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 14TH ST STE 200
AUBURN NE
68305-1760
US

IV. Provider business mailing address

3784 L RD
SYRACUSE NE
68446-7432
US

V. Phone/Fax

Practice location:
  • Phone: 402-274-3709
  • Fax:
Mailing address:
  • Phone: 402-297-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1863
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: