Provider Demographics
NPI:1073311791
Name:DISHAW, JENNIFER MARIE (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:DISHAW
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 S 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1899
Mailing Address - Country:US
Mailing Address - Phone:402-671-2858
Mailing Address - Fax:
Practice Address - Street 1:6440 N 66TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1138
Practice Address - Country:US
Practice Address - Phone:402-619-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24172164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse