Provider Demographics
NPI:1619789120
Name:COX, JENNIFER SUE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:COX
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 1:805 W 29TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-5559
Mailing Address - Country:US
Mailing Address - Phone:402-510-4608
Mailing Address - Fax:
Practice Address - Street 1:805 W 29TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5559
Practice Address - Country:US
Practice Address - Phone:402-510-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT44898376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide