Individual
JORDAN D BLACKWILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6901 N 72ND ST, OMAHA, NE 68122-1709
(402) 572-2121
Mailing address
16478 ERSKINE ST, OMAHA, NE 68116-2523
(402) 779-5870
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
68419
NE
367500000X
Certified Registered Nurse Anesthetist
D139751
IA
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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