Healthcare Provider Details

I. General information

NPI: 1265368401
Provider Name (Legal Business Name): CHERYL BRODERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N 87TH ST
OMAHA NE
68114-2806
US

IV. Provider business mailing address

720 N 87TH ST
OMAHA NE
68114-2806
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number77694
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: