Healthcare Provider Details

I. General information

NPI: 1215845029
Provider Name (Legal Business Name): JETAUN WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 BLONDO ST
OMAHA NE
68111-4338
US

IV. Provider business mailing address

2611 BLONDO ST
OMAHA NE
68111-4338
US

V. Phone/Fax

Practice location:
  • Phone: 531-375-1663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: