Provider Demographics
NPI:1437872702
Name:VANECEK, JILLIAN (RN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:VANECEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5930 S 58TH ST STE W
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3653
Mailing Address - Country:US
Mailing Address - Phone:402-423-6402
Mailing Address - Fax:402-423-6422
Practice Address - Street 1:10818 ELM ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4820
Practice Address - Country:US
Practice Address - Phone:402-502-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76147163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE76147OtherREGISTERED NURSE LICENSE