MEDICARE: LAURA E WILWERDING MD

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
1	208000000X	Pediatrics Physician	20894	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20894	OTHER	NE	NE LICENSE

General Provider Information

NPI Number	:	1376594523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA E WILWERDING MD

Provider Business Mailing Address
First Line	:	8723 OAK ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3051
Country	:	US
Telephone Number	:	402-934-0087
Fax Number	:	402-932-6848

Provider Business Practice Location Address
First Line	:	8723 OAK ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3051
Country	:	US
Telephone Number	:	402-934-0087
Fax Number	:	402-932-6848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/07/2025

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