Healthcare Provider Details

I. General information

NPI: 1912878380
Provider Name (Legal Business Name): JENNIFER DJEMISSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 10/24/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 73RD ST
OMAHA NE
68124-2335
US

IV. Provider business mailing address

13914 HICKORY ST
OMAHA NE
68144-1100
US

V. Phone/Fax

Practice location:
  • Phone: 402-898-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number63972
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: