1750614517 NPI number — KATHRYN ANN WELLS PT

Table of content: KATHRYN ANN WELLS PT (NPI 1750614517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750614517 NPI number — KATHRYN ANN WELLS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLS
Provider First Name:
KATHRYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARYMEE
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750614517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 DODGE ST
Provider Second Line Business Mailing Address:
CHILDREN'S HOSPITAL & MEDICAL CENTER
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-955-5400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 DODGE ST
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL & MEDICAL CENTER - REHAB SERVICES
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-955-8350
Provider Business Practice Location Address Fax Number:
402-955-7396
Provider Enumeration Date:
09/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  1908 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)