Healthcare Provider Details

I. General information

NPI: 1548890833
Provider Name (Legal Business Name): JONATHAN VIRNIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

11661 TRUMBLE LOUP W
BELLEVUE NE
68123-1182
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9383
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1811078
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: