Healthcare Provider Details

I. General information

NPI: 1336057249
Provider Name (Legal Business Name): BRIDGETT ANNA JENSEN MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MAIN ST AC222B
WAYNE NE
68787-1172
US

IV. Provider business mailing address

821 1/2 MAIN ST
WAYNE NE
68787-1358
US

V. Phone/Fax

Practice location:
  • Phone: 402-375-7310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1331
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: