Healthcare Provider Details

I. General information

NPI: 1811730286
Provider Name (Legal Business Name): ASHLEY NICOLE JENSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY NICOLE BORCHERS

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 MERCY RD STE 109
OMAHA NE
68106-2629
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-2273
  • Fax: 402-354-6680
Mailing address:
  • Phone: 402-354-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number126593
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3130
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: