Healthcare Provider Details

I. General information

NPI: 1508603010
Provider Name (Legal Business Name): JORDAN GUDE RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 COLD SPRING RD
LINCOLN NE
68512-1110
US

IV. Provider business mailing address

1132 COLD SPRING RD
LINCOLN NE
68512-1110
US

V. Phone/Fax

Practice location:
  • Phone: 402-499-0000
  • Fax:
Mailing address:
  • Phone: 402-499-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number160808
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: