Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 21444 | NE |
NPI | 1457309239 |
---|---|
Provider Name | Wendy J Grant |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-8102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 29/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557580 | (05) | NE |
H68289 | (02) | NE |