Provider Demographics
NPI:1598528010
Name:WILTMAN, KAYLA ROSE
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ROSE
Last Name:WILTMAN
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 1:211 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68784-5014
Mailing Address - Country:US
Mailing Address - Phone:402-287-2061
Mailing Address - Fax:
Practice Address - Street 1:211 10TH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:NE
Practice Address - Zip Code:68784-5014
Practice Address - Country:US
Practice Address - Phone:402-287-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant