Healthcare Provider Details

I. General information

NPI: 1962337345
Provider Name (Legal Business Name): JOSSELYN LEON JIMENEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 HIDCOTE DR STE 300
LINCOLN NE
68516-5569
US

IV. Provider business mailing address

5801 HIDCOTE DR STE 300
LINCOLN NE
68516-5569
US

V. Phone/Fax

Practice location:
  • Phone: 531-207-3086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: