Healthcare Provider Details

I. General information

NPI: 1437790862
Provider Name (Legal Business Name): JAYD MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 FLATEN AVE
GERING NE
69341-1850
US

IV. Provider business mailing address

1900 FLATEN AVE
GERING NE
69341-1850
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-5555
  • Fax: 308-436-4352
Mailing address:
  • Phone: 308-436-5555
  • Fax: 308-436-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: