Provider Demographics
NPI:1306993308
Name:WYMER, RONALD (PLMHP)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:WYMER
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 Q ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-981-7900
Mailing Address - Fax:402-597-2349
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-981-7900
Practice Address - Fax:402-597-2349
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health