Healthcare Provider Details

I. General information

NPI: 1255568002
Provider Name (Legal Business Name): JESSICA KATHLEEN GOELLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST CHILDREN'S HOSP & MED CENTER - ANESTHESIOLOGY
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST CHILDREN'S HOSP & MED CENTER - ANESTHESIOLOGY
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-8972
  • Fax: 402-955-5848
Mailing address:
  • Phone: 402-955-8972
  • Fax: 402-955-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number1183
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: