Provider Demographics
NPI:1225208945
Name:FRANKLIN, JAY NATHAN (SFA,CIS,CVT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:NATHAN
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:SFA,CIS,CVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2001
Mailing Address - Country:US
Mailing Address - Phone:402-917-3531
Mailing Address - Fax:402-614-0683
Practice Address - Street 1:911 N 105TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2001
Practice Address - Country:US
Practice Address - Phone:402-917-3531
Practice Address - Fax:402-614-0683
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47246ZC0007X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE246W00000XOtherCCI
NE246X00000XOtherCCI