Active NPI
Mary Jo Wellendorf
- Chore Provider
- Elkhorn, NE
National Provider Identifier
1104630292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chore Provider
- Practice address
- 20614 Pine St
Elkhorn, NE 68022-2667 - Phone
- (402) 690-4341
- NPI assigned
- Feb 6, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chore Provider | 372500000X | NE | Primary |
Addresses
Primary practice location
20614 Pine St
Elkhorn, NE 68022-2667
Mailing address
20614 Pine St
Elkhorn, NE 68022-2667
Phone (402) 690-4341
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740009600000",
"number": "1104630292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20614 PINE ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680222667",
"telephone_number": "402-690-4341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20614 PINE ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680222667",
"telephone_number": "402-690-4341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLENDORF",
"first_name": "MARY",
"middle_name": "JO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-02-06",
"last_updated": "2025-02-20",
"certification_date": "2025-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "372500000X",
"taxonomy_group": "",
"desc": "Chore Provider",
"state": "NE",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhorn, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.