Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 112578 | NE |
NPI | 1083192462 |
---|---|
Provider Name | Kay Ritzdorf Wieser |
First Address | Columbus, NE 68601-4944 |
Second Address | Columbus, NE 68601-4944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2018 |
Last Update Date | 30/07/2018 |