Healthcare Provider Details

I. General information

NPI: 1184553901
Provider Name (Legal Business Name): JOLIE FAJEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N 89TH ST STE 202
OMAHA NE
68114-4072
US

IV. Provider business mailing address

220 N 89TH ST STE 202
OMAHA NE
68114-4072
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-5750
  • Fax: 402-502-5750
Mailing address:
  • Phone: 402-502-5750
  • Fax: 402-502-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number98349
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: