Healthcare Provider Details

I. General information

NPI: 1336822402
Provider Name (Legal Business Name): JESSICA SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 N 66TH ST
LINCOLN NE
68505-2481
US

IV. Provider business mailing address

451 N 66TH ST
LINCOLN NE
68505-2481
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-3130
  • Fax:
Mailing address:
  • Phone: 402-486-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSS-368
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: