Provider Demographics
NPI:1588479141
Name:ANDERSON, JESSICA JANE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:ANDERSON
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 1:913 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-7225
Mailing Address - Country:US
Mailing Address - Phone:402-369-1901
Mailing Address - Fax:
Practice Address - Street 1:913 MEADOW LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-7225
Practice Address - Country:US
Practice Address - Phone:402-369-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor