Healthcare Provider Details

I. General information

NPI: 1962831156
Provider Name (Legal Business Name): MS. WENDY MACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W 15TH ST
WAHOO NE
68066-1280
US

IV. Provider business mailing address

2744 COUNTY RD N
WESTON NE
68070-4030
US

V. Phone/Fax

Practice location:
  • Phone: 402-443-4555
  • Fax:
Mailing address:
  • Phone: 402-613-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number624
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: