Healthcare Provider Details

I. General information

NPI: 1760484356
Provider Name (Legal Business Name): JENNIFER ANN GENTHE A.P.R.N., C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

7001 A ST SUITE 110
LINCOLN NE
68510-4201
US

IV. Provider business mailing address

7001 A ST SUITE 110
LINCOLN NE
68510-4201
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-0800
  • Fax: 408-489-6803
Mailing address:
  • Phone: 402-489-0800
  • Fax: 408-489-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number110715
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: