Individual
DAVID A. WISTHUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8303 DODGE ST, OMAHA, NE 68114-4108
(402) 354-2360
(402) 354-2440
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2213
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891295697
—
IA
05
—
47068731716
—
NE
Enumeration date
02/19/2018
Last updated
05/09/2018
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