Healthcare Provider Details

I. General information

NPI: 1689313744
Provider Name (Legal Business Name): JENNIFER M PETERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 S 138TH ST
OMAHA NE
68137-2913
US

IV. Provider business mailing address

5321 S 138TH ST
OMAHA NE
68137-2913
US

V. Phone/Fax

Practice location:
  • Phone: 402-960-3193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61987
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: