MEDICARE: MS. JESSICA J WOLLBERG APRN

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	363LA2100X	Acute Care Nurse Practitioner	110856	NE
2	363LP0200X	Pediatric Nurse Practitioner	110856	NE

General Provider Information

NPI Number	:	1104018647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA J WOLLBERG APRN

Provider Business Mailing Address
First Line	:	8200 DODGE ST
Second Line	:	CHILDREN'S HOSPITAL
City	:	OMAHA
State	:	NE
Zip	:	68114-4113
Country	:	US
Telephone Number	:	402-955-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 DODGE ST
Second Line	:	CHILDREN'S HOSPITAL - PEDIATRIC SURGERY
City	:	OMAHA
State	:	NE
Zip	:	68114-4113
Country	:	US
Telephone Number	:	402-955-7400
Fax Number	:	402-955-7405

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	12/08/2025

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