Provider Demographics
NPI:1871390765
Name:WESLEY, ROGER B
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:B
Last Name:WESLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14824 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1469
Mailing Address - Country:US
Mailing Address - Phone:402-306-6871
Mailing Address - Fax:
Practice Address - Street 1:7197 PINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2811
Practice Address - Country:US
Practice Address - Phone:402-556-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist