Healthcare Provider Details

I. General information

NPI: 1629139662
Provider Name (Legal Business Name): CITY OF WISNER CITY CLERK TREAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/27/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 AVENUE D
WISNER NE
68791-2307
US

IV. Provider business mailing address

10802 FARNAM DR
OMAHA NE
68154-3237
US

V. Phone/Fax

Practice location:
  • Phone: 877-218-4392
  • Fax: 877-343-0131
Mailing address:
  • Phone: 877-218-4392
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number69
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JAMES
Title or Position: CITY CLERK/TREASURER
Credential:
Phone: 402-529-6616