Provider Demographics
NPI:1629851753
Name:STARKEVICIUS, JENNIFER K (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:STARKEVICIUS
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:PO BOX 3781
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0781
Mailing Address - Country:US
Mailing Address - Phone:402-740-1121
Mailing Address - Fax:
Practice Address - Street 1:6024 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1611
Practice Address - Country:US
Practice Address - Phone:402-740-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA175854363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care