Individual
SEPTEMBER LEIGH WANZENRIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
6901 S 84TH ST, LA VISTA, NE 68128
(866) 389-2727
Mailing address
5205 CASS ST, OMAHA, NE 68132-2818
(402) 301-4348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2004
NE
363LF0000X
Family Nurse Practitioner
Primary
112351
NE
363LF0000X
Family Nurse Practitioner
A148987
IA
Other
Enumeration date
08/24/2017
Last updated
06/12/2018
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