Healthcare Provider Details

I. General information

NPI: 1396538666
Provider Name (Legal Business Name): SHERRY LYNN PEDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 S 81ST ST
RALSTON NE
68127-2737
US

IV. Provider business mailing address

3120 WILLIT ST
OMAHA NE
68112-1748
US

V. Phone/Fax

Practice location:
  • Phone: 402-612-4226
  • Fax:
Mailing address:
  • Phone: 402-612-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: