Healthcare Provider Details

I. General information

NPI: 1427656776
Provider Name (Legal Business Name): MRS. JACQUELINE SUE WEGENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MAIN ST
MADISON NE
68748-6009
US

IV. Provider business mailing address

501 S 8TH ST
HUMPHREY NE
68642-3105
US

V. Phone/Fax

Practice location:
  • Phone: 402-454-3723
  • Fax:
Mailing address:
  • Phone: 402-993-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1418
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: