Individual
MRS. TRACEY E KOLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8303 DODGE ST, SUITE 300, OMAHA, NE 68114-4108
(403) 354-5250
(402) 354-3437
Mailing address
PO BOX 10190, VIRGINIA BEACH, VA 23450-0190
(800) 477-5240
(757) 463-6572
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002099
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025044500
—
NE
Enumeration date
05/24/2010
Last updated
12/13/2013
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