Provider Demographics
NPI:1518136928
Name:JENDRO, RACHEL NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:NICOLE
Last Name:JENDRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4293
Mailing Address - Country:US
Mailing Address - Phone:402-483-4292
Mailing Address - Fax:
Practice Address - Street 1:1101 S 70TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4293
Practice Address - Country:US
Practice Address - Phone:402-483-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2361208600000X
OH58.002374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCF220D243Medicare PIN
NCNCF220AMedicare PIN