Healthcare Provider Details

I. General information

NPI: 1588290399
Provider Name (Legal Business Name): JORDAN PONEC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 S 138TH ST
OMAHA NE
68137-2913
US

IV. Provider business mailing address

5321 S 138TH ST
OMAHA NE
68137-2913
US

V. Phone/Fax

Practice location:
  • Phone: 402-895-4000
  • Fax:
Mailing address:
  • Phone: 402-895-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number84809
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: