Provider Demographics
NPI:1326355330
Name:OLBERDING, KENT DWAINE (CCP)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:DWAINE
Last Name:OLBERDING
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HARRIS DR.
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:402-316-9760
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIRCLE
Practice Address - Street 2:DAVID GRANT USAF MEDICAL CENTER
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:94535
Practice Address - Country:US
Practice Address - Phone:707-423-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE40242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist