Healthcare Provider Details

I. General information

NPI: 1871301101
Provider Name (Legal Business Name): CLARA JEAN GENEREUX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 70TH ST
LINCOLN NE
68510-2462
US

IV. Provider business mailing address

575 S 70TH ST STE 435
LINCOLN NE
68510-2463
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-8000
  • Fax:
Mailing address:
  • Phone: 402-219-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3195
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: