Healthcare Provider Details

I. General information

NPI: 1750488284
Provider Name (Legal Business Name): TERRY NYE WOOLDRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 22ND ST
FREMONT NE
68025-2606
US

IV. Provider business mailing address

220 E 22ND ST
FREMONT NE
68025-2606
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-5500
  • Fax: 402-727-6047
Mailing address:
  • Phone: 402-727-5500
  • Fax: 402-727-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18519
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: