Provider Demographics
NPI:1720886153
Name:PEDERSEN, BILLIE JO
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:JO
Last Name:PEDERSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 S 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2129
Mailing Address - Country:US
Mailing Address - Phone:402-306-7907
Mailing Address - Fax:
Practice Address - Street 1:5156 S 124TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2129
Practice Address - Country:US
Practice Address - Phone:402-306-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No251C00000XAgenciesDay Training, Developmentally Disabled Services