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General NPI Number Information
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NPI Number | 1346345295
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Entity Type | Individual
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Provider Name | CARRIE A JURACEK P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1103 GALVIN RD S
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City | BELLEVUE
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State | NE
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Zip | 68005-3002
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Country | US
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Telephone | 402-292-1072
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Fax | 402-292-0742
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Provider Business Mailing Address
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Address Line | 1103 GALVIN RD S STE G
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City | BELLEVUE
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State | NE
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Zip | 68005-3000
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Country | US
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Telephone | 402-292-1072
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Fax | 402-292-0742
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1023
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License Number State | NE
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