Provider Demographics
NPI:1912539289
Name:MASEK, JACLYN TAYLOR
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:TAYLOR
Last Name:MASEK
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 1:610 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-1003
Mailing Address - Country:US
Mailing Address - Phone:402-443-4537
Mailing Address - Fax:
Practice Address - Street 1:5000 SAINT PAUL AVE # SMB6141
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-2760
Practice Address - Country:US
Practice Address - Phone:402-466-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program