1770590838 NPI number — MRS. JILL RENEE REED APRN

Table of content: MRS. JILL RENEE REED APRN (NPI 1770590838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770590838 NPI number — MRS. JILL RENEE REED APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
JILL
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
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:
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:
1770590838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLDERGE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-995-3987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 S BURLINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68901-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-463-6300
Provider Business Practice Location Address Fax Number:
402-834-0665
Provider Enumeration Date:
08/02/2006

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:  110380 , 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: 37413 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47079417000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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