1073777967 NPI number — DR. JENNIFER LYNN HOWARD D.C., B.S., F.A.S.A.

Table of content: ALEXANDRIA GROMALA PA-C (NPI 1437043411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073777967 NPI number — DR. JENNIFER LYNN HOWARD D.C., B.S., F.A.S.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., B.S., F.A.S.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073777967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3675 N 129TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68164-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-885-8783
Provider Business Mailing Address Fax Number:
402-885-8794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3675 N 129TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68164-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-885-8783
Provider Business Practice Location Address Fax Number:
402-885-8794
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1522 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1073777967 . This is a "SANFORD HEALTH PLAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 258442 . This is a "PRINCIPAL" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025738000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258442 . This is a "MIDLANDS CHOICE/AETNA/CIGNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 27236 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1073777967 . This is a "COVENTRY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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