Provider Demographics
NPI:1770568909
Name:WYENO, GARY L (AUD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:WYENO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2115 N KANSAS AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2644
Mailing Address - Country:US
Mailing Address - Phone:402-463-2431
Mailing Address - Fax:402-462-2486
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:MIDWEST EAR NOSE & THROAT SPECIALISTS PC
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2644
Practice Address - Country:US
Practice Address - Phone:402-463-2431
Practice Address - Fax:402-462-2486
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47053662301Medicaid