Provider Demographics
NPI:1003613969
Name:DIDIER, JOLENE GRACE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:GRACE
Last Name:DIDIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1453
Mailing Address - Country:US
Mailing Address - Phone:308-380-1829
Mailing Address - Fax:
Practice Address - Street 1:4169 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1453
Practice Address - Country:US
Practice Address - Phone:308-380-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion