Healthcare Provider Details

I. General information

NPI: 1376626879
Provider Name (Legal Business Name): BRENDA SUE KORTH-WURDINGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 R ST
NELIGH NE
68756
US

IV. Provider business mailing address

1901 SHEIDAN DR
NORFOLK NE
68701
US

V. Phone/Fax

Practice location:
  • Phone: 402-887-4681
  • Fax:
Mailing address:
  • Phone: 402-379-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number736
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: