Provider Demographics
NPI:1992322853
Name:KULWICKI, CONNIE MAE (RN, CDE)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MAE
Last Name:KULWICKI
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2958
Mailing Address - Country:US
Mailing Address - Phone:308-865-2370
Mailing Address - Fax:308-865-2167
Practice Address - Street 1:3219 CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2958
Practice Address - Country:US
Practice Address - Phone:308-865-2370
Practice Address - Fax:308-865-2167
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE38889163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator