Healthcare Provider Details

I. General information

NPI: 1265246342
Provider Name (Legal Business Name): JORDAN C GILFRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-9802
US

IV. Provider business mailing address

450 E 23RD ST
FREMONT NE
68025-9802
US

V. Phone/Fax

Practice location:
  • Phone: 402-941-1699
  • Fax: 402-941-1688
Mailing address:
  • Phone: 402-941-1699
  • Fax: 402-941-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number82221
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: