Provider Demographics
NPI:1497043517
Name:SVANCARA, JENNY ALICIA (RN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ALICIA
Last Name:SVANCARA
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 1:19111 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3262
Mailing Address - Country:US
Mailing Address - Phone:402-525-4754
Mailing Address - Fax:
Practice Address - Street 1:19111 ADAMS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3262
Practice Address - Country:US
Practice Address - Phone:402-525-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69241163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine