Healthcare Provider Details

I. General information

NPI: 1568710739
Provider Name (Legal Business Name): JENNIFER MARIE THIELLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 S 132ND ST STE 100
OMAHA NE
68144-2573
US

IV. Provider business mailing address

11284 NORTHRIDGE DR
GRETNA NE
68028-6905
US

V. Phone/Fax

Practice location:
  • Phone: 531-867-7487
  • Fax: 402-226-4827
Mailing address:
  • Phone: 402-332-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number111382
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: