Provider Demographics
NPI:1316817323
Name:BURNETT, JEREMY ALAN
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:BURNETT
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 1:7910 S 93RD ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2876
Mailing Address - Country:US
Mailing Address - Phone:402-590-4794
Mailing Address - Fax:
Practice Address - Street 1:7910 S 93RD ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2876
Practice Address - Country:US
Practice Address - Phone:402-590-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion