Healthcare Provider Details

I. General information

NPI: 1386533099
Provider Name (Legal Business Name): MS. JILL JANELLE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N COTNER BLVD APT 316
LINCOLN NE
68505-2367
US

IV. Provider business mailing address

225 N COTNER BLVD APT 316
LINCOLN NE
68505-2367
US

V. Phone/Fax

Practice location:
  • Phone: 402-730-3087
  • Fax:
Mailing address:
  • Phone: 402-730-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: