Healthcare Provider Details

I. General information

NPI: 1922305143
Provider Name (Legal Business Name): OLIVIA SUE WOITA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N 117TH AVE
OMAHA NE
68154-2211
US

IV. Provider business mailing address

206 N 117TH AVE
OMAHA NE
68154-2211
US

V. Phone/Fax

Practice location:
  • Phone: 402-616-2257
  • Fax:
Mailing address:
  • Phone: 402-616-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA100022
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111221
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: