Healthcare Provider Details

I. General information

NPI: 1679144646
Provider Name (Legal Business Name): ASHLEY MARY KENKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S 45TH ST
OMAHA NE
68198-2002
US

IV. Provider business mailing address

1502 S 10TH ST APT 302
OMAHA NE
68108-3664
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-0900
  • Fax:
Mailing address:
  • Phone: 402-650-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14593
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: