Provider Demographics
NPI:1275990905
Name:HALLOWELL, JOLI (PA-C)
Entity Type:Individual
Prefix:
First Name:JOLI
Middle Name:
Last Name:HALLOWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:717 N 190TH PLZ
Practice Address - Street 2:STE. 3100
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3913
Practice Address - Country:US
Practice Address - Phone:402-815-1325
Practice Address - Fax:402-815-2020
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731742Medicaid
NE10025837400Medicaid
NE10026480100Medicaid
NE47068731742Medicaid