Provider Demographics
NPI:1699586859
Name:STUCKY, JILLIAN RUTH (CNA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RUTH
Last Name:STUCKY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68366-2524
Mailing Address - Country:US
Mailing Address - Phone:402-380-6155
Mailing Address - Fax:
Practice Address - Street 1:4535 NORMAL BLVD STE 235
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2891
Practice Address - Country:US
Practice Address - Phone:402-207-1050
Practice Address - Fax:402-313-1501
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X, 376J00000X, 372500000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker