Provider Demographics
NPI:1750196861
Name:ANNIN, JACK
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:ANNIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-4526
Mailing Address - Country:US
Mailing Address - Phone:402-714-4564
Mailing Address - Fax:
Practice Address - Street 1:2204 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-4526
Practice Address - Country:US
Practice Address - Phone:402-714-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion