Provider Demographics
NPI:1295523819
Name:VALENTINE, JERRY L
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:VALENTINE
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 1:9910 N 48TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1548
Mailing Address - Country:US
Mailing Address - Phone:402-612-0388
Mailing Address - Fax:
Practice Address - Street 1:3419 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1254
Practice Address - Country:US
Practice Address - Phone:469-490-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider