Provider Demographics
NPI:1932863065
Name:OLTMAN, JESSICA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:OLTMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 AZALEA PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5678
Mailing Address - Country:US
Mailing Address - Phone:402-617-7775
Mailing Address - Fax:
Practice Address - Street 1:7621 AZALEA PL
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5678
Practice Address - Country:US
Practice Address - Phone:402-617-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22087164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty