Healthcare Provider Details

I. General information

NPI: 1275977654
Provider Name (Legal Business Name): JESSICA BARBARA SHANK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA B JOHNSON MD

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S. 45TH ST
OMAHA NE
68198-0001
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number31836
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: