Healthcare Provider Details

I. General information

NPI: 1164239885
Provider Name (Legal Business Name): JEFFORY STUMPF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17422 CINNAMON CIR
OMAHA NE
68135-3203
US

IV. Provider business mailing address

17422 CINNAMON CIR
OMAHA NE
68135-3203
US

V. Phone/Fax

Practice location:
  • Phone: 402-490-9780
  • Fax:
Mailing address:
  • Phone: 402-490-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH12672739
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: