Provider Demographics
NPI:1881251189
Name:HARRISON, JENNIFER D
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LABATO
Other - Last Name:DEMESQUITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP AND PMHNP
Mailing Address - Street 1:8550 CUTHILLS CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9474
Mailing Address - Country:US
Mailing Address - Phone:402-659-9292
Mailing Address - Fax:
Practice Address - Street 1:ALIVATION HEALTH
Practice Address - Street 2:8550 CUTHILLS CIRCLE
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526
Practice Address - Country:US
Practice Address - Phone:402-476-6060
Practice Address - Fax:402-476-6809
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112759363LF0000X
NE2021183722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily