Healthcare Provider Details

I. General information

NPI: 1366230963
Provider Name (Legal Business Name): JAELYN MARIE RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 O ST STE 119B
LINCOLN NE
68510-2565
US

IV. Provider business mailing address

3180 OVERLAND TRL
LINCOLN NE
68503-3301
US

V. Phone/Fax

Practice location:
  • Phone: 402-200-5555
  • Fax:
Mailing address:
  • Phone: 402-904-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: