Provider Demographics
NPI:1376828889
Name:WATSABAUGH, JILL MARIE (RN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:WATSABAUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13336 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-895-4000
Mailing Address - Fax:402-895-1607
Practice Address - Street 1:13336 INDUSTRIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1124
Practice Address - Country:US
Practice Address - Phone:402-895-4000
Practice Address - Fax:402-895-1607
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse