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General NPI Number Information
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NPI Number | 1801575683
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Entity Type | Individual
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Provider Name | JORDAN R SPENCER APRN
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Gender | Female
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 3308 SAMSON WAY STE 203
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City | BELLEVUE
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State | NE
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Zip | 68123-3235
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Country | US
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Telephone | 402-717-7680
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Fax | 402-717-8806
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Provider Business Mailing Address
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Address Line | 7261 MERCY RD
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City | OMAHA
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State | NE
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Zip | 68124-2311
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Country | US
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Telephone | 402-398-6248
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Fax | 402-829-8513
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 114870
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License Number State | NE
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