MEDICARE: RENAE G WORTZ NP

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	363LF0000X	Family Nurse Practitioner	4704246800	MI
2	363LA2200X	Adult Health Nurse Practitioner	111956	NE

General Provider Information

NPI Number	:	1760703037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE G WORTZ NP

Provider Business Mailing Address
First Line	:	444 REGENCY PARKWAY DR STE 104
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3779
Country	:	US
Telephone Number	:	402-932-2296
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 REGENCY PARKWAY DR STE 104
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3779
Country	:	US
Telephone Number	:	402-932-2296
Fax Number	:

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

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	10/11/2016

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