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General NPI Number Information
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NPI Number | 1396096400
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Entity Type | Individual
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Provider Name | JACKIE E ERB
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Gender | Female
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 910 20TH ST
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City | GOTHENBURG
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State | NE
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Zip | 69138-1237
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Country | US
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Telephone | 308-537-3661
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 21ST ST
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City | GOTHENBURG
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State | NE
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Zip | 69138-2501
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Country | US
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Telephone | 402-318-1735
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 201242161RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101285
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 69233
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License Number State | NE
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