Healthcare Provider Details

I. General information

NPI: 1154530228
Provider Name (Legal Business Name): JENNIFER LYNNE KRUEGER MA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNNE KRUEGER

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 DODGE STREET HPER 100
OMAHA NE
68182
US

IV. Provider business mailing address

5716 S 95TH PLZ APT 8
OMAHA NE
68127-3487
US

V. Phone/Fax

Practice location:
  • Phone: 402-554-3170
  • Fax:
Mailing address:
  • Phone: 402-540-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number402
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: