# NEBRASKA MEDICAL AESTHETICS, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Devenu Medical Rejuvenation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780874826
- **Authorized official:** JULIE L WADDELL MD (DIRECTOR)
- **Authorized official phone:** (402) 397-2300

## Contact information

- **Practice address:** 9802 NICHOLAS ST, SUITE 305, OMAHA, NE 68114-2106
- **Practice address phone:** (402) 397-2300
- **Practice address fax:** (402) 397-2303
- **Mailing address:** 9802 NICHOLAS ST, SUITE 305, OMAHA, NE 68114-2106
- **Mailing address phone:** (402) 397-2300
- **Mailing address fax:** (402) 397-2303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 07/25/2007
- **Last updated:** 06/30/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00196 | BCBS | NE |
| 05 | — | 10025539700 | — | NE |