Healthcare Provider Details

I. General information

NPI: 1477466282
Provider Name (Legal Business Name): CANDRA DANELLE WIEDEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 N LINCOLN AVE
YORK NE
68467-1001
US

IV. Provider business mailing address

2319 N LINCOLN AVE
YORK NE
68467-1001
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-1444
  • Fax: 402-363-6623
Mailing address:
  • Phone: 402-362-1444
  • Fax: 402-363-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number81372
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: