Provider Demographics
NPI:1376741264
Name:FOSSEN, KATIE ANN-WEATHERL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ANN-WEATHERL
Last Name:FOSSEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1276
Mailing Address - Country:US
Mailing Address - Phone:402-483-2886
Mailing Address - Fax:402-489-9684
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 508
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-483-2886
Practice Address - Fax:402-489-9684
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2011-07-26
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Provider Licenses
StateLicense IDTaxonomies
NE26366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology