Individual
MRS. JESSICA LYNNE PROVAZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
17810 WELCH PLZ, OMAHA, NE 68135-1620
(402) 891-0600
(402) 891-1239
Mailing address
17810 WELCH PLZ, OMAHA, NE 68135-1620
(402) 891-0600
(402) 891-1239
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11599
NE
Other
Enumeration date
03/30/2007
Last updated
09/03/2010
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