Healthcare Provider Details

I. General information

NPI: 1679868301
Provider Name (Legal Business Name): KELLY JO JUEDEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N 13TH ST
NORFOLK NE
68701-2669
US

IV. Provider business mailing address

1414 N 13TH ST
NORFOLK NE
68701-2669
US

V. Phone/Fax

Practice location:
  • Phone: 402-316-4606
  • Fax: 402-316-3469
Mailing address:
  • Phone: 402-316-4606
  • Fax: 402-316-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number64413
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111223
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: