Provider Demographics
NPI:1104375708
Name:REDINGER, KELLEEN (BSN)
Entity Type:Individual
Prefix:MRS
First Name:KELLEEN
Middle Name:
Last Name:REDINGER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 HOME ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3629
Mailing Address - Country:US
Mailing Address - Phone:402-834-0308
Mailing Address - Fax:
Practice Address - Street 1:1824 HOME ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3629
Practice Address - Country:US
Practice Address - Phone:402-834-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE53723163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse