Provider Demographics
NPI:1407205230
Name:ULMER, ENOCH NATHANEAL
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:NATHANEAL
Last Name:ULMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-6460
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:444 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3727
Practice Address - Country:US
Practice Address - Phone:402-559-6460
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE518235Z00000X
NE1952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist