Provider Demographics
NPI:1578269031
Name:JACKMAN, PAIGE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:JACKMAN
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 1:8309 BURT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2920
Mailing Address - Country:US
Mailing Address - Phone:402-936-0224
Mailing Address - Fax:
Practice Address - Street 1:8309 BURT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2920
Practice Address - Country:US
Practice Address - Phone:402-936-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide