Healthcare Provider Details

I. General information

NPI: 1821380403
Provider Name (Legal Business Name): MARY ANN WILKEN RN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOOLWORTH AVE
OMAHA NE
68105-1851
US

IV. Provider business mailing address

4201 WOOLWORTH AVE
OMAHA NE
68105-1752
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-7000
  • Fax: 402-444-3943
Mailing address:
  • Phone: 402-444-7000
  • Fax: 402-444-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number39709
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: