Healthcare Provider Details

I. General information

NPI: 1235808445
Provider Name (Legal Business Name): JAZMIN YACAMAN STRUBLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 NORTHWOODS DR STE 100
LINCOLN NE
68505-2093
US

IV. Provider business mailing address

2107 N CLARKSON ST
FREMONT NE
68025-2625
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-3440
  • Fax:
Mailing address:
  • Phone: 402-317-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2571
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: