Provider Demographics
NPI:1386622900
Name:REISER, GWENDOLYN MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:REISER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985440 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5440
Mailing Address - Country:US
Mailing Address - Phone:402-559-4161
Mailing Address - Fax:402-559-6391
Practice Address - Street 1:985440 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5440
Practice Address - Country:US
Practice Address - Phone:402-559-4161
Practice Address - Fax:402-559-6391
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS