Healthcare Provider Details

I. General information

NPI: 1033188321
Provider Name (Legal Business Name): LINDA KROEGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 S 70TH ST
LINCOLN NE
68506-2960
US

IV. Provider business mailing address

2611 S 70TH ST
LINCOLN NE
68506-2960
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-4200
  • Fax: 402-423-4201
Mailing address:
  • Phone: 402-423-4200
  • Fax: 402-423-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-44576
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number53-44576
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number112386
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: