Provider Demographics
NPI:1083397210
Name:WILSHUSEN, TAMMY RANAE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RANAE
Last Name:WILSHUSEN
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 1:1305 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-1402
Mailing Address - Country:US
Mailing Address - Phone:308-754-4433
Mailing Address - Fax:
Practice Address - Street 1:1305 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-1402
Practice Address - Country:US
Practice Address - Phone:308-754-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider