Provider Demographics
NPI:1417766924
Name:JACKSON, TREMANISHA AVEIA LASHUNDA
Entity type:Individual
Prefix:MS
First Name:TREMANISHA
Middle Name:AVEIA LASHUNDA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1614
Mailing Address - Country:US
Mailing Address - Phone:402-480-0067
Mailing Address - Fax:
Practice Address - Street 1:6401 WHITEWATER LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4557
Practice Address - Country:US
Practice Address - Phone:402-902-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant