MEDICARE: MS. KELLY JO JUEDEN 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	163W00000X	Registered Nurse	64413	NE
2	363L00000X	Nurse Practitioner	111223	NE

General Provider Information

NPI Number	:	1679868301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY JO JUEDEN APRN

Provider Business Mailing Address
First Line	:	1414 N 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-316-4606
Fax Number	:	402-316-3469

Provider Business Practice Location Address
First Line	:	1414 N 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-316-4606
Fax Number	:	402-316-3469

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

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	08/26/2016

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