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General NPI Number Information
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NPI Number | 1376626879
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Entity Type | Individual
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Provider Name | BRENDA SUE KORTH-WURDINGER PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1108 R ST
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City | NELIGH
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State | NE
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Zip | 68756
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Country | US
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Telephone | 402-887-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 SHEIDAN DR
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City | NORFOLK
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State | NE
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Zip | 68701
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Country | US
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Telephone | 402-379-8380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 736
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License Number State | NE
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