Individual
JENNIFER R MICHAELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
16120 W DODGE RD, OMAHA, NE 68118-2049
(402) 354-0707
(402) 354-0711
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
074838
IA
363A00000X
Physician Assistant
Primary
1825
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47068731742
—
NE
05
—
47068731751
—
NE
Enumeration date
06/11/2013
Last updated
02/17/2015
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