Provider Demographics
NPI:1306651575
Name:CARRIGER, JEREMIAH DANIEL
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:DANIEL
Last Name:CARRIGER
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 1:305 CHATEAU DR APT 13
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2159
Mailing Address - Country:US
Mailing Address - Phone:217-602-1092
Mailing Address - Fax:
Practice Address - Street 1:305 CHATEAU DR APT 13
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2159
Practice Address - Country:US
Practice Address - Phone:217-602-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X, 3747P1801X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7494Medicaid
NE8148Medicaid