Healthcare Provider Details

I. General information

NPI: 1437872702
Provider Name (Legal Business Name): JILLIAN VANECEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN RYAN RN

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 ELM ST
OMAHA NE
68144-4820
US

IV. Provider business mailing address

5930 S 58TH ST STE W
LINCOLN NE
68516-3653
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-0617
  • Fax:
Mailing address:
  • Phone: 402-423-6402
  • Fax: 402-423-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number76147
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: