Individual
JORDAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5814 S 105TH ST, OMAHA, NE 68127-2909
(402) 321-6867
Mailing address
5814 S 105TH ST, OMAHA, NE 68127-2909
(402) 321-6867
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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