Healthcare Provider Details

I. General information

NPI: 1326117243
Provider Name (Legal Business Name): JOLENE ANN PIKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LINCOLN
BEATRICE NE
68310
US

IV. Provider business mailing address

3000 LINCOLN
BEATRICE NE
68310
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-6137
  • Fax: 402-223-7589
Mailing address:
  • Phone: 402-223-6137
  • Fax: 402-223-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number110368
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: