Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 20857 | NE |
NPI | 1417995192 |
---|---|
Provider Name | Ann Edmunds |
First Address | Omaha, NE 68130-2396 |
Second Address | Omaha, NE 68130-2396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 13/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10-00173 | UNITED HEALTHCARE (01) | |
2513028 | (05) | IA |
34176 | BCBS (01) | NE |
47083434300 | (05) | NE |
G70396 | (02) |