Provider Demographics
NPI:1750488284
Name:WOOLDRIDGE, TERRY NYE (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:NYE
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2606
Mailing Address - Country:US
Mailing Address - Phone:402-727-5500
Mailing Address - Fax:402-727-6047
Practice Address - Street 1:220 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2606
Practice Address - Country:US
Practice Address - Phone:402-727-5500
Practice Address - Fax:402-727-6047
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18519208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4707111013Medicaid
NE264518NDMedicare ID - Type Unspecified
F86806Medicare UPIN