Healthcare Provider Details

I. General information

NPI: 1770320210
Provider Name (Legal Business Name): JODI ANN HURST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 VICTORY PARK DR
LINCOLN NE
68510-2484
US

IV. Provider business mailing address

420 VICTORY PARK DR
LINCOLN NE
68510-2484
US

V. Phone/Fax

Practice location:
  • Phone: 402-805-1490
  • Fax:
Mailing address:
  • Phone: 402-805-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number27560
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: