Individual
JED EARL HOLLENBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 S 48TH ST, LINCOLN, NE 68506-1283
(402) 489-0200
Mailing address
1600 S 48TH ST, LINCOLN, NE 68506-1283
(402) 489-0200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0329
SD
363A00000X
Physician Assistant
Primary
553
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100908
MIDLANDS CHOICE
—
01
—
23040
BCBS OF NE
NE
01
—
P00730251
RAILROAD MEDICARE
—
Enumeration date
06/23/2006
Last updated
10/21/2009
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