Healthcare Provider Details

I. General information

NPI: 1295290575
Provider Name (Legal Business Name): PATRICK JESPERSEN REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 NIOBRARA AVE
HEMINGFORD NE
69348-3102
US

IV. Provider business mailing address

911 NIOBRARA AVE
HEMINGFORD NE
69348-3102
US

V. Phone/Fax

Practice location:
  • Phone: 308-487-7425
  • Fax:
Mailing address:
  • Phone: 308-487-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number79339
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: