Basic Information
| Provider Information | |||||||||
| NPI: | 1770691867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGLIM | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 W DODGE RD | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029556877 | ||||||||
| FaxNumber: | 4029556880 | ||||||||
| Practice Location | |||||||||
| Address1: | 13808 W MAPLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681646231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029553000 | ||||||||
| FaxNumber: | 4029557055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22458 | NE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 243299 | 01 | NE | MIDLANDS CHOICE | OTHER | 3433 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER | 47068937200 | 05 | NE | MEDICAID | 1201303 | 01 | NE | SHARE ADVANTAGE | OTHER |