Healthcare Provider Details

I. General information

NPI: 1376614149
Provider Name (Legal Business Name): WANDA KAY STUMPFF RP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11134 Q ST
OMAHA NE
68137-3609
US

IV. Provider business mailing address

249 S HWS CLEVELAND BLVD
ELKHORN NE
68022-5689
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-5244
  • Fax:
Mailing address:
  • Phone: 402-763-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberG49002703
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: