MEDICARE: ROBERTA KROEGER 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	363LF0000X	Family Nurse Practitioner	110142	NE

General Provider Information

NPI Number	:	1396819090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA KROEGER APRN

Provider Business Mailing Address
First Line	:	3540 VILLAGE DR STE 100
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4706
Country	:	US
Telephone Number	:	402-420-7113
Fax Number	:	402-328-8314

Provider Business Practice Location Address
First Line	:	3540 VILLAGE DR STE 100
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4706
Country	:	US
Telephone Number	:	402-420-7113
Fax Number	:	402-328-8314

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	05/27/2020

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