Provider Demographics
NPI:1407817596
Name:TREBIL, JENNIFER J (PAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:TREBIL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:WOLTKAMP
Other - Suffix:
Other - Last Name Type:Other Name
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:402-354-6171
Practice Address - Street 1:1120 N 103RD PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1114
Practice Address - Country:US
Practice Address - Phone:402-391-5055
Practice Address - Fax:402-391-5053
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1179363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1407817596Medicaid
NE100264481-00Medicaid
NE099099223Medicare PIN