Healthcare Provider Details

I. General information

NPI: 1831975697
Provider Name (Legal Business Name): KERRY WEDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY JOY WEDEL

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 S 51ST ST
OMAHA NE
68117-1955
US

IV. Provider business mailing address

4215 S 37TH ST
OMAHA NE
68107-1208
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-1027
  • Fax: 531-299-1038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number76816
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: