Provider Demographics
NPI:1093690760
Name:PEDERSEN, JONATHAN L
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:NE
Mailing Address - Zip Code:68979-2441
Mailing Address - Country:US
Mailing Address - Phone:402-762-5045
Mailing Address - Fax:
Practice Address - Street 1:301 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:NE
Practice Address - Zip Code:68979-2441
Practice Address - Country:US
Practice Address - Phone:402-762-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider