Provider Demographics
NPI:1700509494
Name:WIEDEMAN, KRISTA ELIZABETH
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ELIZABETH
Last Name:WIEDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FLATEN AVE
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1850
Mailing Address - Country:US
Mailing Address - Phone:308-436-5555
Mailing Address - Fax:308-436-4352
Practice Address - Street 1:1900 FLATEN AVE
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1850
Practice Address - Country:US
Practice Address - Phone:308-436-5555
Practice Address - Fax:308-436-4352
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator