Provider Demographics
NPI:1700509288
Name:IRLANDA, JASON SHANE SKINNER (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SHANE SKINNER
Last Name:IRLANDA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:SHANE
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:954 S 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2811
Mailing Address - Country:US
Mailing Address - Phone:860-617-0360
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:800-451-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE93786163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice