Provider Demographics
NPI:1609604255
Name:WOODAREK, KELSEY (RN, BSN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WOODAREK
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 TIMBERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4709
Mailing Address - Country:US
Mailing Address - Phone:402-827-1840
Mailing Address - Fax:
Practice Address - Street 1:12001 TIMBERRIDGE DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68133-4709
Practice Address - Country:US
Practice Address - Phone:402-827-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE96589163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool