Provider Demographics
NPI:1083824734
Name:JAUKEN, LONNIE LEE (ATC,PTA)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:LEE
Last Name:JAUKEN
Suffix:
Gender:M
Credentials:ATC,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2050
Mailing Address - Country:US
Mailing Address - Phone:308-995-5447
Mailing Address - Fax:
Practice Address - Street 1:1215 TIBBALS ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1255
Practice Address - Country:US
Practice Address - Phone:308-995-6134
Practice Address - Fax:308-995-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer