Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 16659 | NE |
NPI | 1023068053 |
---|---|
Provider Name | Stephen I Rennard |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557531 | (05) | NE |
B90838 | (02) | NE |