Individual
AMY DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
7822 DAVENPORT ST, OMAHA, NE 68114-3629
(402) 391-4855
(402) 391-6818
Mailing address
7822 DAVENPORT ST, OMAHA, NE 68114-3629
(402) 391-4855
(402) 391-6818
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
101470
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118046
NBCRNA
NE
Enumeration date
04/11/2018
Last updated
04/11/2018
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