Healthcare Provider Details

I. General information

NPI: 1295783538
Provider Name (Legal Business Name): CAROL ANN FENNELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CAROL ANN KECK

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 WAKELEY PLAZA
OMAHA NE
68114-3651
US

IV. Provider business mailing address

7801 WAKELEY PLAZA
OMAHA NE
68114-3651
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-4855
  • Fax: 402-391-6818
Mailing address:
  • Phone: 402-391-4855
  • Fax: 402-391-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100850
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704290975
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: