Healthcare Provider Details

I. General information

NPI: 1487076162
Provider Name (Legal Business Name): NATURALLY HEALTHY KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8723 OAK ST
OMAHA NE
68124-3051
US

IV. Provider business mailing address

8723 OAK ST
OMAHA NE
68124-3051
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-0087
  • Fax:
Mailing address:
  • Phone: 402-934-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA E WILWERDING
Title or Position: PRESIDENT
Credential: MD
Phone: 402-934-0087