MEDICARE: MS. GWENDOLYN MARIE REISER M.S.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1386622900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENDOLYN MARIE REISER M.S.

Provider Business Mailing Address
First Line	:	985440 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-5440
Country	:	US
Telephone Number	:	402-559-4161
Fax Number	:	402-559-6391

Provider Business Practice Location Address
First Line	:	985440 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-5440
Country	:	US
Telephone Number	:	402-559-4161
Fax Number	:	402-559-6391

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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