1831312305 NPI number — MRS. KELLI RENAE WELVAERT PLMHP

Table of content: MRS. KELLI RENAE WELVAERT PLMHP (NPI 1831312305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831312305 NPI number — MRS. KELLI RENAE WELVAERT PLMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELVAERT
Provider First Name:
KELLI
Provider Middle Name:
RENAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PLMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831312305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68005-0616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-292-7722
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 SO 42 ST
Provider Second Line Business Practice Location Address:
HEARTLAND FAMILY SERVICE
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-552-7416
Provider Business Practice Location Address Fax Number:
402-552-7497
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7239 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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