Healthcare Provider Details

I. General information

NPI: 1568458628
Provider Name (Legal Business Name): JODY DECKER MILLER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

11415 S 43RD ST
BELLEVUE NE
68123-1072
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7401
  • Fax: 402-232-9398
Mailing address:
  • Phone: 402-294-7401
  • Fax: 402-232-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number111194
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: