Provider Demographics
NPI:1497438618
Name:LOLLMAN, KATIE MICHELLE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MICHELLE
Last Name:LOLLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14621 HEYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-1332
Mailing Address - Country:US
Mailing Address - Phone:402-786-5340
Mailing Address - Fax:
Practice Address - Street 1:14621 HEYWOOD ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1332
Practice Address - Country:US
Practice Address - Phone:402-786-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant