Provider Demographics
NPI:1437136405
Name:RINE, JILL S
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:RINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GINGER WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-9404
Mailing Address - Country:US
Mailing Address - Phone:402-421-3335
Mailing Address - Fax:402-421-2625
Practice Address - Street 1:2625 STOCKWELL ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5755
Practice Address - Country:US
Practice Address - Phone:402-421-3335
Practice Address - Fax:402-421-2625
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE741363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073374004Medicaid
NENA1987004Medicare PIN