Individual
MRS. SUSAN LEE WOLLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
(402) 559-7200
(402) 559-9344
Mailing address
7123 S. HARRISON DR. APT 108, LAVISTA, NE 68128
(402) 239-0028
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1513
NE
Other
Enumeration date
05/11/2010
Last updated
01/21/2015
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