Individual
CAROL J WECKMULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4101 WOOLWORTH AVE, OMAHA, NE 68105-1850
(800) 451-5796
Mailing address
4101 WOOLWORTH AVE, OMAHA, NE 68105-1850
(800) 451-5796
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17011
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10025024000
MEDICAID RHC
NE
05
—
47042628508
—
NE
Enumeration date
02/10/2006
Last updated
03/20/2018
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