Healthcare Provider Details

I. General information

NPI: 1538712260
Provider Name (Legal Business Name): KIRSTEN A BOEDEKER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD
OMAHA NE
68124-2319
US

IV. Provider business mailing address

7500 MERCY RD
OMAHA NE
68124-2319
US

V. Phone/Fax

Practice location:
  • Phone: 855-524-4001
  • Fax: 402-398-5589
Mailing address:
  • Phone: 855-524-4001
  • Fax: 402-398-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH155444
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112883
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: