Individual
JILL DETAVERNIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5606 S 147TH ST, OMAHA, NE 68137-2648
(402) 715-8200
Mailing address
8152 S 184TH TER, OMAHA, NE 68136-6448
(402) 715-8200
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
01/30/2026
Last updated
01/30/2026
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