Healthcare Provider Details

I. General information

NPI: 1952352130
Provider Name (Legal Business Name): LUCILE E WRENSHALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988095 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8095
US

IV. Provider business mailing address

988095 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8095
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-9800
  • Fax: 402-559-9840
Mailing address:
  • Phone: 402-559-9800
  • Fax: 402-559-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number21784
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: