Healthcare Provider Details

I. General information

NPI: 1699669788
Provider Name (Legal Business Name): JENNIFER TREVILLION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 VINTON ST STE 100
OMAHA NE
68105-3863
US

IV. Provider business mailing address

4060 VINTON ST STE 100
OMAHA NE
68105-3863
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-9880
  • Fax: 402-625-0081
Mailing address:
  • Phone: 402-991-9880
  • Fax: 402-625-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: