Basic Information
| Provider Information | |||||||||
| NPI: | 1326355330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLBERDING | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | DWAINE | ||||||||
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| Credential: | CCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 HARRIS DR. | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023169760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 BODIN CIRCLE | ||||||||
| Address2: | DAVID GRANT USAF MEDICAL CENTER | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 94535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233735 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2010 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 242T00000X | 40 | NE | Y | Technologists, Technicians & Other Technical Service Providers | Perfusionist |
No ID Information.