Healthcare Provider Details

I. General information

NPI: 1720366289
Provider Name (Legal Business Name): KATHLEEN DEGUZMAN YAO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7308 S 142ND ST
OMAHA NE
68138-6804
US

IV. Provider business mailing address

19316 J ST
OMAHA NE
68135-3763
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-4200
  • Fax:
Mailing address:
  • Phone: 712-490-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number64983
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111181
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number111181
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: