Healthcare Provider Details

I. General information

NPI: 1992513188
Provider Name (Legal Business Name): JACLYN MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 MARINDA ST
OMAHA NE
68105-8500
US

IV. Provider business mailing address

4444 MARINDA ST
OMAHA NE
68105-8500
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-1760
  • Fax:
Mailing address:
  • Phone: 531-299-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number103195
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: