Healthcare Provider Details

I. General information

NPI: 1912522921
Provider Name (Legal Business Name): KELLI-ANN CORRAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982185 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3135
US

IV. Provider business mailing address

982185 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3135
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5380
  • Fax: 402-559-5137
Mailing address:
  • Phone: 402-559-5380
  • Fax: 402-559-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number81785-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: