Provider Demographics
NPI:1538952775
Name:JENNINGS, ANDREA DESHELLE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DESHELLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 VINTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3862
Mailing Address - Country:US
Mailing Address - Phone:402-991-9880
Mailing Address - Fax:
Practice Address - Street 1:13011 BROWNE CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1767
Practice Address - Country:US
Practice Address - Phone:213-379-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide