Healthcare Provider Details

I. General information

NPI: 1437727781
Provider Name (Legal Business Name): TAMMY LEA WIESELER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SAINT JAMES AVE
WYNOT NE
68792-2086
US

IV. Provider business mailing address

56608 894 RD
WYNOT NE
68792-3010
US

V. Phone/Fax

Practice location:
  • Phone: 402-357-2121
  • Fax: 402-357-2524
Mailing address:
  • Phone: 402-357-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number50339
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: