Healthcare Provider Details

I. General information

NPI: 1467263111
Provider Name (Legal Business Name): TANNA BEVERLY JENSEN-NELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N 89TH ST STE 202
OMAHA NE
68114-4072
US

IV. Provider business mailing address

220 N 89TH ST STE 202
OMAHA NE
68114-4072
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-5750
  • Fax: 402-502-1261
Mailing address:
  • Phone: 402-502-5750
  • Fax: 402-502-1261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number92175
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: