Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 110130 | NE |
NPI | 1053349142 |
---|---|
Provider Name | Mrs. Kathleen Ann Popelka |
First Address | Omaha, NE 68105 |
Second Address | Omaha, NE 68105-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 12/04/2011 |