Provider Demographics
NPI:1144102328
Name:SIEDHOFF, JUDITH ROSE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ROSE
Last Name:SIEDHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15651 BOBWHITE TRL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-3329
Mailing Address - Country:US
Mailing Address - Phone:402-525-0841
Mailing Address - Fax:
Practice Address - Street 1:15651 BOBWHITE TRL
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3329
Practice Address - Country:US
Practice Address - Phone:402-525-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NEAD983742433747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant