Provider Demographics
NPI:1578010955
Name:HALLDORSON, JYLLYAN CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:JYLLYAN
Middle Name:CHRISTINE
Last Name:HALLDORSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 S 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6029
Mailing Address - Country:US
Mailing Address - Phone:402-578-4932
Mailing Address - Fax:
Practice Address - Street 1:3814 S 186TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6029
Practice Address - Country:US
Practice Address - Phone:402-578-4932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112096363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care