Provider Demographics
NPI:1063461184
Name:PHELPS, JILL A (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:PHELPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 CENTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3252
Mailing Address - Country:US
Mailing Address - Phone:402-558-2500
Mailing Address - Fax:402-558-5522
Practice Address - Street 1:4951 CENTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3252
Practice Address - Country:US
Practice Address - Phone:402-558-2500
Practice Address - Fax:402-558-5522
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE110261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026287600Medicaid
NEQ67963Medicare UPIN
NE10026287600Medicaid