Healthcare Provider Details

I. General information

NPI: 1083569701
Provider Name (Legal Business Name): JACOB JENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BLUFF ST
WINNEBAGO NE
68071-9703
US

IV. Provider business mailing address

225 BLUFF ST
WINNEBAGO NE
68071-9703
US

V. Phone/Fax

Practice location:
  • Phone: 402-243-1542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18680
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number18680
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: