Provider Demographics
NPI:1184331340
Name:VIDLAK, JENNIFER (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VIDLAK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 S 183RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-6438
Mailing Address - Country:US
Mailing Address - Phone:402-212-1782
Mailing Address - Fax:
Practice Address - Street 1:7912 S 183RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-6438
Practice Address - Country:US
Practice Address - Phone:402-212-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64582163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant