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Organization
NEBRASKA MEDICAL AESTHETICS, LLC
Active
Organization
NEBRASKA MEDICAL AESTHETICS, LLC
Active
Other names
Devenu Medical Rejuvenation Center
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE L WADDELL MD (DIRECTOR)
(402) 397-2300
Entity
Organization
Contact information
Practice address
9802 NICHOLAS ST, SUITE 305, OMAHA, NE 68114-2106
(402) 397-2300
(402) 397-2303
Mailing address
9802 NICHOLAS ST, SUITE 305, OMAHA, NE 68114-2106
(402) 397-2300
(402) 397-2303
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00196
BCBS
NE
05
—
10025539700
—
NE
Enumeration date
07/25/2007
Last updated
06/30/2009
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