Provider Demographics
NPI:1467684092
Name:WEGENER, JESSICA ANN (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:WEGENER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23514 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4381
Mailing Address - Country:US
Mailing Address - Phone:402-669-2705
Mailing Address - Fax:402-932-6878
Practice Address - Street 1:13809 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1117
Practice Address - Country:US
Practice Address - Phone:480-208-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NE720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered