Healthcare Provider Details

I. General information

NPI: 1023942786
Provider Name (Legal Business Name): JORDAN MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 S 146TH CIR
OMAHA NE
68144-2117
US

IV. Provider business mailing address

1405 S 208TH ST
ELKHORN NE
68022-2249
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-1008
  • Fax:
Mailing address:
  • Phone: 402-881-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberH13834131
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: