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NPI Code Detail

MEDICARE: TODD A. WOOLLEN M.D.

MEDICARE: TODD A. WOOLLEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34701IA
2207Q00000XFamily Medicine Physician21191NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
230555OTHERIAWELLMARK BC/BS

General Provider Information

NPI Number : 1164424701
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD A. WOOLLEN M.D.
Provider Business Mailing Address
First Line : 2201 N BROADWELL AVE
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-2153
Country : US
Telephone Number : 308-382-3660
Fax Number : 308-389-5111
Provider Business Practice Location Address
First Line : 2201 N BROADWELL AVE
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-2153
Country : US
Telephone Number : 308-382-3660
Fax Number : 308-389-5111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 08/16/2022

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Directions to “ TODD A. WOOLLEN M.D.” Practice Location

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