Healthcare Provider Details

I. General information

NPI: 1831273788
Provider Name (Legal Business Name): JODY A PEDERSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982035 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2035
US

IV. Provider business mailing address

982035 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2035
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-9604
  • Fax: 402-559-7779
Mailing address:
  • Phone: 402-559-9604
  • Fax: 402-559-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110587
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: