Provider Demographics
NPI:1376153197
Name:BEAUDETTE, MATILDA R (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:R
Last Name:BEAUDETTE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2273
Mailing Address - Country:US
Mailing Address - Phone:402-206-9772
Mailing Address - Fax:
Practice Address - Street 1:4951 CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3252
Practice Address - Country:US
Practice Address - Phone:402-558-2500
Practice Address - Fax:402-558-5522
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily