Provider Demographics
NPI:1821036260
Name:MCADAM, JILLENNE S (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLENNE
Middle Name:S
Last Name:MCADAM
Suffix:
Gender:F
Credentials:PA-C
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 67250
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7250
Mailing Address - Country:US
Mailing Address - Phone:402-328-2907
Mailing Address - Fax:888-965-0959
Practice Address - Street 1:250 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2226
Practice Address - Country:US
Practice Address - Phone:402-643-2971
Practice Address - Fax:402-646-4635
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE626363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES97991Medicare UPIN