Healthcare Provider Details

I. General information

NPI: 1710898424
Provider Name (Legal Business Name): PEYTON JULIA JANICEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6934 WHITEWATER LN
LINCOLN NE
68521-8997
US

IV. Provider business mailing address

6934 WHITEWATER LN
LINCOLN NE
68521-8997
US

V. Phone/Fax

Practice location:
  • Phone: 308-920-2782
  • Fax:
Mailing address:
  • Phone: 308-920-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1590
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: