Healthcare Provider Details

I. General information

NPI: 1871554154
Provider Name (Legal Business Name): PATRICIA WESEMAN ST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: PATRICIA WESEMAN

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 W FAIDLEY AVE
GRAND ISLAND NE
68803-4109
US

IV. Provider business mailing address

3004 W FAIDLEY AVE
GRAND ISLAND NE
68803-4109
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax:
Mailing address:
  • Phone: 308-382-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1133
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: