Healthcare Provider Details

I. General information

NPI: 1023937224
Provider Name (Legal Business Name): JENNIFER MATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

19610 ELK RIDGE CIR
ELKHORN NE
68022-6438
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4442
  • Fax:
Mailing address:
  • Phone: 402-679-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number117048
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: