Provider Demographics
NPI:1104486992
Name:GULZOW, MICHAELA A (APRN)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:A
Last Name:GULZOW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:A
Other - Last Name:OSTDIEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:945 E ZERO ST
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1556
Mailing Address - Country:US
Mailing Address - Phone:402-387-2800
Mailing Address - Fax:402-387-2804
Practice Address - Street 1:945 E ZERO ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1556
Practice Address - Country:US
Practice Address - Phone:402-387-2800
Practice Address - Fax:402-387-2804
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112847363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner