Provider Demographics
NPI:1982016606
Name:WEIDNER, BRENDA (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S HOSPITAL & MEDICAL CENTER
Mailing Address - Street 2:8200 DODGE STREET
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-676-6479
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL & MEDICAL CENTER
Practice Address - Street 2:8200 DODGE STREET
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-955-4495
Practice Address - Fax:402-955-5362
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7168208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics