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General NPI Number Information
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NPI Number | 1871715508
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Entity Type | Individual
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Provider Name | KELLY SUE HATTERMAN MT
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4101 WOOLWORTH AVE
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City | OMAHA
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State | NE
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Zip | 68105-1850
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Country | US
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Telephone | 402-346-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 8016 OAKWOOD ST
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City | RALSTON
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State | NE
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Zip | 68127-3736
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Country | US
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Telephone | 402-884-1740
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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 | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number | 213581
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License Number State | NE
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