Healthcare Provider Details

I. General information

NPI: 1093318792
Provider Name (Legal Business Name): JENA NICHOLE MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S 15TH ST
OMAHA NE
68102-2207
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-2273
  • Fax: 402-815-9745
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114772
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: