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General NPI Number Information
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NPI Number | 1275493199
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Entity Type | Individual
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Provider Name | CONNER JACE WILSON
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 21011 TREASURE ISLAND RD
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City | PLATTSMOUTH
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State | NE
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Zip | 68048-7169
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Country | US
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Telephone | 531-364-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 11635 ARBOR ST
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City | OMAHA
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State | NE
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Zip | 68144-5000
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Country | US
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Telephone | 402-503-5320
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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