Provider Demographics
NPI:1205180841
Name:NEESE, JESSE C (MASTER TATTOOIST)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:C
Last Name:NEESE
Suffix:
Gender:M
Credentials:MASTER TATTOOIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3601
Mailing Address - Country:US
Mailing Address - Phone:402-556-8500
Mailing Address - Fax:
Practice Address - Street 1:159 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3601
Practice Address - Country:US
Practice Address - Phone:402-556-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical