MEDICARE: JILLIAN VANECEK RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	76147	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76147	OTHER	NE	REGISTERED NURSE LICENSE

General Provider Information

NPI Number	:	1437872702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN VANECEK RN

Provider Business Mailing Address
First Line	:	5930 S 58TH ST STE W
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-3653
Country	:	US
Telephone Number	:	402-423-6402
Fax Number	:	402-423-6422

Provider Business Practice Location Address
First Line	:	10818 ELM ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4820
Country	:	US
Telephone Number	:	402-502-0617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	09/22/2022

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