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General NPI Number Information
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NPI Number | 1225824022
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Entity Type | Individual
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Provider Name | JORDAN ANN KOEHLER
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Gender | Female
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 724 CENTRAL AVE
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City | NEBRASKA CITY
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State | NE
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Zip | 68410-2451
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Country | US
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Telephone | 402-699-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 707 C ST # 707
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City | LINCOLN
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State | NE
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Zip | 68502-1139
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Country | US
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Telephone | 402-414-7880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | H13968894
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License Number State | NE
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