Healthcare Provider Details

I. General information

NPI: 1043830219
Provider Name (Legal Business Name): JENNIFER N DIAMOND DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16120 W DODGE RD
OMAHA NE
68118-2049
US

IV. Provider business mailing address

825 S 169TH ST
OMAHA NE
68118-9300
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-0610
  • Fax: 402-354-0649
Mailing address:
  • Phone: 402-354-5677
  • Fax: 402-354-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2809
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: