MEDICARE: JACQUELINE WAYMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	113530	NE

General Provider Information

NPI Number	:	1093394843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE WAYMAN

Provider Business Mailing Address
First Line	:	1006 N 49TH AVE APT 1
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-1550
Country	:	US
Telephone Number	:	616-490-0281
Fax Number	:

Provider Business Practice Location Address
First Line	:	11404 W DODGE RD STE 600
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2593
Country	:	US
Telephone Number	:	616-490-0281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	04/07/2021

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Directions to “ JACQUELINE WAYMAN ” Practice Location

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