Provider Demographics
NPI:1194518092
Name:GREDER, OWEN MASON
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:MASON
Last Name:GREDER
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 1:1410 MANATT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1755
Mailing Address - Country:US
Mailing Address - Phone:531-205-0122
Mailing Address - Fax:
Practice Address - Street 1:715 N 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1286
Practice Address - Country:US
Practice Address - Phone:531-205-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion