Provider Demographics
NPI:1164706693
Name:BENDER, THERESA JOANN (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JOANN
Last Name:BENDER
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:8901 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3327
Practice Address - Country:US
Practice Address - Phone:402-354-8600
Practice Address - Fax:402-354-8965
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111282363LF0000X, 363L00000X
IAA131660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731712Medicaid
IA1164706693Medicaid
NE47068731798Medicaid
NE10026480100Medicaid
NE47068731724Medicaid
NE47068731741Medicaid
NE47068731749Medicaid
NE099099150Medicare PIN
IA1164706693Medicaid