Individual provider Active NPI

Jessica J Wollberg, APRN

  • Acute Care Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1104018647
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
110856 Issued in NE
Practice address
8200 Dodge St
Children'S Hospital - Pediatric Surgery
Omaha, NE 68114-4113
Phone
(402) 955-7400
Fax
(402) 955-7405
NPI assigned
Aug 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 110856 NE Primary
Pediatric Nurse Practitioner 363LP0200X 110856 NE

Addresses

Primary practice location

8200 Dodge St
Children'S Hospital - Pediatric Surgery
Omaha, NE 68114-4113

Mailing address

8200 Dodge St
Children'S Hospital
Omaha, NE 68114-4113
Phone (402) 955-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
110856NEMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital & Medical Center Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1104018647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 DODGE ST",
            "address_2": "CHILDREN'S HOSPITAL",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144113",
            "telephone_number": "402-955-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 DODGE ST",
            "address_2": "CHILDREN'S HOSPITAL - PEDIATRIC SURGERY",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144113",
            "telephone_number": "402-955-7400",
            "fax_number": "402-955-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLBERG",
        "first_name": "JESSICA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-17",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NE",
            "license": "110856",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NE",
            "license": "110856",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.