Provider Demographics
NPI:1447065446
Name:RIEDL, JENNIFER NICOLE (CNA; CMA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:RIEDL
Suffix:
Gender:F
Credentials:CNA; CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13304 W CENTER RD STE 225
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3456
Mailing Address - Country:US
Mailing Address - Phone:402-697-7536
Mailing Address - Fax:402-614-7579
Practice Address - Street 1:470 MAXWELL PLZ UNIT 327
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3064
Practice Address - Country:US
Practice Address - Phone:402-697-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE162182376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide