Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 110533 | NE |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 110533 | NE |
NPI | 1235340258 |
---|---|
Provider Name | Brenda Kay Wallingford |
First Address | Papillion, NE 68133-4771 |
Second Address | Omaha, NE 68124-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 02/03/2010 |