Provider Demographics
NPI:1215824701
Name:KOLLBAUM, JORDAN ALEXANDER
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXANDER
Last Name:KOLLBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GALVIN RD N
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4852
Mailing Address - Country:US
Mailing Address - Phone:402-360-3991
Mailing Address - Fax:
Practice Address - Street 1:1909 VICKI LN STE 110
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4542
Practice Address - Country:US
Practice Address - Phone:402-844-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion