Healthcare Provider Details

I. General information

NPI: 1316653082
Provider Name (Legal Business Name): JILL J ROLFSON RD, LMNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL; J BENES

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S 56TH ST
LINCOLN NE
68506-2111
US

IV. Provider business mailing address

PO BOX 24607
OMAHA NE
68124-0607
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-1500
  • Fax:
Mailing address:
  • Phone: 402-955-5400
  • Fax: 402-955-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1276
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: