MEDICARE: KARRIE VAN NORTWICK RN

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	163W00000X	Registered Nurse	50287	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598248684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRIE VAN NORTWICK RN

Provider Business Mailing Address
First Line	:	PO BOX 160
Second Line	:
City	:	NORTH BEND
State	:	NE
Zip	:	68649-0160
Country	:	US
Telephone Number	:	402-652-3268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 WALNUT ST
Second Line	:
City	:	NORTH BEND
State	:	NE
Zip	:	68649-5016
Country	:	US
Telephone Number	:	402-652-3268
Fax Number	:

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

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	09/13/2018

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