1265730519 NPI number — JENNIFER FRANCES BANFIELD APRN

Table of content: JENNIFER FRANCES BANFIELD APRN (NPI 1265730519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265730519 NPI number — JENNIFER FRANCES BANFIELD APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANFIELD
Provider First Name:
JENNIFER
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARSELL
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265730519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N 30TH 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:
68131-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-498-6540
Provider Business Mailing Address Fax Number:
402-498-6638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14080 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYS TOWN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68010-7513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-778-6900
Provider Business Practice Location Address Fax Number:
402-778-6968
Provider Enumeration Date:
03/10/2011

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: 363LF0000X , with the licence number:  111227 , 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)





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