Provider Demographics
NPI:1619476934
Name:BUCKENDAHL, DARA JOAN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:JOAN
Last Name:BUCKENDAHL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1751
Mailing Address - Country:US
Mailing Address - Phone:402-436-1211
Mailing Address - Fax:402-458-3211
Practice Address - Street 1:5130 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1751
Practice Address - Country:US
Practice Address - Phone:402-436-1211
Practice Address - Fax:402-458-3211
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62453163WN0002X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care