Individual
JEFFREY A JOHANNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
16120 W DODGE RD, OMAHA, NE 68118-2049
(402) 354-0610
(402) 354-0611
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
001824
IA
363A00000X
Physician Assistant
Primary
885
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026480100
—
NE
05
—
47068731734
—
NE
05
—
47068731741
—
NE
05
—
47068731749
—
NE
05
—
47068731785
—
NE
Enumeration date
04/11/2006
Last updated
02/02/2017
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