Provider Demographics
NPI:1982683918
Name:FIALA, JENNA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ELIZABETH
Last Name:FIALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 A ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4299
Mailing Address - Country:US
Mailing Address - Phone:402-484-3199
Mailing Address - Fax:402-484-3196
Practice Address - Street 1:7001 A ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4299
Practice Address - Country:US
Practice Address - Phone:402-484-3199
Practice Address - Fax:402-484-3196
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43337174400000X
NE25147207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06606725Medicaid
CO4796175OtherCIGNA
CO840592369-08OtherPACIFICARE
COANTHEM BCBSOtherTH98908
CO11266262OtherCAQH
CO802702Medicare ID - Type UnspecifiedMEDICARE
CO06606725Medicaid