Provider Demographics
NPI:1548969819
Name:JUENGST, ALEXIS TAYLOR
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:TAYLOR
Last Name:JUENGST
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 1:11444 HASCALL ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4507
Mailing Address - Country:US
Mailing Address - Phone:402-390-6470
Mailing Address - Fax:
Practice Address - Street 1:11444 HASCALL ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4507
Practice Address - Country:US
Practice Address - Phone:402-390-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant