Provider Demographics
NPI:1962561431
Name:DOLPHENS, KATIE M
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:DOLPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 S 81ST ST
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2720
Mailing Address - Country:US
Mailing Address - Phone:402-593-7321
Mailing Address - Fax:
Practice Address - Street 1:5033 S 81ST ST
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127-2720
Practice Address - Country:US
Practice Address - Phone:402-593-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician