Healthcare Provider Details

I. General information

NPI: 1801129911
Provider Name (Legal Business Name): JAQUELYN L TRESEMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 S 84TH ST
PAPILLION NE
68046-4122
US

IV. Provider business mailing address

PO BOX 642117
OMAHA NE
68164-8117
US

V. Phone/Fax

Practice location:
  • Phone: 402-343-4328
  • Fax:
Mailing address:
  • Phone: 402-717-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number111071
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: