Healthcare Provider Details

I. General information

NPI: 1144605767
Provider Name (Legal Business Name): JOHANNA VOLLERTSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHANNA SPENCER APRN-NP

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 L ST
ORD NE
68862-1275
US

IV. Provider business mailing address

2707 L ST
ORD NE
68862-1275
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-4202
  • Fax: 308-728-3500
Mailing address:
  • Phone: 308-728-4202
  • Fax: 308-728-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111832
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: