Provider Demographics
NPI:1598573669
Name:JURGENA, WYNDI EVE
Entity type:Individual
Prefix:
First Name:WYNDI
Middle Name:EVE
Last Name:JURGENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WYNDI
Other - Middle Name:EVE
Other - Last Name:DICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 S ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6139
Mailing Address - Country:US
Mailing Address - Phone:402-462-5176
Mailing Address - Fax:402-462-5120
Practice Address - Street 1:625 S ROSS AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6139
Practice Address - Country:US
Practice Address - Phone:402-462-5176
Practice Address - Fax:402-462-5120
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health