MEDICARE: JAKA M MONTANGE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0222X	Critical Care Pediatric Nurse Practitioner	112463	NE
2	363LA2100X	Acute Care Nurse Practitioner	112463	NE

General Provider Information

NPI Number	:	1609369263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKA M MONTANGE APRN

Provider Business Mailing Address
First Line	:	8200 DODGE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-4113
Country	:	US
Telephone Number	:	402-955-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 DODGE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-4113
Country	:	US
Telephone Number	:	402-955-4200
Fax Number	:	402-955-3262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	12/08/2025

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