Provider Demographics
NPI:1861869539
Name:CU DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:CU DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:JOLYNN
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-717-0947
Mailing Address - Street 1:601 N 30TH STREET
Mailing Address - Street 2:CU DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:402-717-0947
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH STREET
Practice Address - Street 2:CU DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131
Practice Address - Country:US
Practice Address - Phone:402-717-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7419207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty