Healthcare Provider Details

I. General information

NPI: 1730826439
Provider Name (Legal Business Name): MAKAELA WADDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

V. Phone/Fax

Practice location:
  • Phone: 402-536-9460
  • Fax:
Mailing address:
  • Phone: 402-552-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number84263
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number114293
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: