Healthcare Provider Details

I. General information

NPI: 1326543125
Provider Name (Legal Business Name): JOLENE EMRICSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEMORIAL STADIUM
LINCOLN NE
68588-6858
US

IV. Provider business mailing address

PO BOX 880128
LINCOLN NE
68588-0128
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-2276
  • Fax:
Mailing address:
  • Phone: 402-472-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: