=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144045295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY LEE KRIE RN, HN-BC, HWNC-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2024
-----------------------------------------------------
Last Update Date | 01/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N 564 AVE
-----------------------------------------------------
City | HARTINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68739-6077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-841-8854
-----------------------------------------------------
Fax | 402-254-3849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N 564 AVE
-----------------------------------------------------
City | HARTINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68739-6077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-841-8854
-----------------------------------------------------
Fax | 402-254-3849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | 64496
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 64496
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------