Provider Demographics
NPI:1962400671
Name:AXT, JENNIFER MARIE (APRN-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:AXT
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W CAPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2003
Mailing Address - Country:US
Mailing Address - Phone:308-385-6252
Mailing Address - Fax:308-385-5683
Practice Address - Street 1:2300 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2003
Practice Address - Country:US
Practice Address - Phone:308-385-6252
Practice Address - Fax:308-385-5683
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00159863OtherPALMENTO D/B/A RR MEDICAR
NEMA0705321OtherDEA NUMBER
NEP00159863OtherPALMENTO D/B/A RR MEDICAR
NE298464Medicare PIN