Healthcare Provider Details

I. General information

NPI: 1780245183
Provider Name (Legal Business Name): CAITLYN B COOKENMASTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD STE 2000
OMAHA NE
68124-2323
US

IV. Provider business mailing address

7710 MERCY RD STE 2000
OMAHA NE
68124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-4909
  • Fax:
Mailing address:
  • Phone: 402-717-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301511929
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37222
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301511929
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number37222
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: