Provider Demographics
NPI:1649752759
Name:KUZELKA, KATHRYN JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:KUZELKA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:DAHLSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:544 SOUTH 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-314-9609
Mailing Address - Fax:
Practice Address - Street 1:544 SOUTH 28TH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-314-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse