Healthcare Provider Details

I. General information

NPI: 1194518621
Provider Name (Legal Business Name): JAELYNN N DUNHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST STE 605
LINCOLN NE
68506-1280
US

IV. Provider business mailing address

PO BOX 860879
MINNEAPOLIS MN
55486-0879
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-3255
  • Fax:
Mailing address:
  • Phone: 402-483-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0009251
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3495
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: