Provider Demographics
NPI:1396819090
Name:KROEGER, ROBERTA (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:KROEGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 VILLAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4706
Mailing Address - Country:US
Mailing Address - Phone:402-420-7113
Mailing Address - Fax:402-328-8314
Practice Address - Street 1:3540 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4706
Practice Address - Country:US
Practice Address - Phone:402-420-7113
Practice Address - Fax:402-328-8314
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily