Provider Demographics
NPI:1609807551
Name:JENNINGS, DOROTHY SUE (DO)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:SUE
Last Name:JENNINGS
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 1:1423 STONE ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2660
Mailing Address - Country:US
Mailing Address - Phone:402-245-3232
Mailing Address - Fax:402-245-4022
Practice Address - Street 1:1423 STONE ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2660
Practice Address - Country:US
Practice Address - Phone:402-245-3232
Practice Address - Fax:402-245-4022
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE298208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
010065263OtherPALMETTO GBA RR MEDICARE
07046OtherBLUE CROSS BLUE SHIELD NE
NEB53853Medicare UPIN
274680Medicare ID - Type Unspecified