Healthcare Provider Details

I. General information

NPI: 1457685489
Provider Name (Legal Business Name): MARY JO BURKHARDT RN, BSN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CENTER RD
OMAHA NE
68106-2714
US

IV. Provider business mailing address

7100 W CENTER RD
OMAHA NE
68106-2714
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9000
  • Fax: 402-506-9093
Mailing address:
  • Phone: 402-506-9000
  • Fax: 402-506-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number40064
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: