MEDICARE: MRS. JULIE L WADDELL MD

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	207Q00000X	Family Medicine Physician	23224	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22192	OTHER	NE	MIDLANDS CHOICE
2	00196	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1700843125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE L WADDELL MD

Provider Business Mailing Address
First Line	:	9802 NICHOLAS STREET
Second Line	:	SUITE 305
City	:	OMAHA
State	:	NE
Zip	:	68114-2106
Country	:	US
Telephone Number	:	402-397-2300
Fax Number	:	402-397-2303

Provider Business Practice Location Address
First Line	:	9802 NICHOLAS STREET
Second Line	:	SUITE 305
City	:	OMAHA
State	:	NE
Zip	:	68114-2106
Country	:	US
Telephone Number	:	402-397-2300
Fax Number	:	402-397-2303

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	06/18/2024

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