Provider Demographics
NPI:1093118325
Name:KUEHLER, MARY PATRICIA (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:KUEHLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 KOENIGSTEIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3664
Mailing Address - Country:US
Mailing Address - Phone:405-644-7329
Mailing Address - Fax:402-644-7212
Practice Address - Street 1:1500 KOENIGSTEIN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3664
Practice Address - Country:US
Practice Address - Phone:405-644-7329
Practice Address - Fax:402-644-7212
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111748363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100257288-00Medicaid