Provider Demographics
NPI:1164907630
Name:CONAHAN, JENNIFER II
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CONAHAN
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 N 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1804
Mailing Address - Country:US
Mailing Address - Phone:531-299-2341
Mailing Address - Fax:531-299-2359
Practice Address - Street 1:8050 N 129TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-1804
Practice Address - Country:US
Practice Address - Phone:531-299-2341
Practice Address - Fax:531-299-2359
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48465163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty