Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 24193 | NE |
NPI | 1154525806 |
---|---|
Provider Name | Kari A Simonsen |
First Address | Omaha, NE 68198-2162 |
Second Address | Omaha, NE 68198-2162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 15/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
24193 | STATE LICENSE (01) | NE |