Provider Demographics
NPI:1295217974
Name:STUBBENDICK, JACKI (RN)
Entity Type:Individual
Prefix:
First Name:JACKI
Middle Name:
Last Name:STUBBENDICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 EDUCATION DR.
Mailing Address - Street 2:PO BOX P
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0520
Mailing Address - Country:US
Mailing Address - Phone:402-269-2388
Mailing Address - Fax:402-269-2402
Practice Address - Street 1:1430 EDUCATION DR.
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-0520
Practice Address - Country:US
Practice Address - Phone:402-269-2388
Practice Address - Fax:402-269-2402
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62271163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool