Provider Demographics
NPI:1649867524
Name:WELLER, DENISE L (RN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:WELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N 102ND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2122
Mailing Address - Country:US
Mailing Address - Phone:866-633-3548
Mailing Address - Fax:
Practice Address - Street 1:1010 N 102ND ST STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2122
Practice Address - Country:US
Practice Address - Phone:866-633-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9202739163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine