Provider Demographics
NPI:1730400631
Name:CZYZ, JENNIFER LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:CZYZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 W CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2388
Mailing Address - Country:US
Mailing Address - Phone:402-397-6600
Mailing Address - Fax:402-397-8318
Practice Address - Street 1:7205 W CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2388
Practice Address - Country:US
Practice Address - Phone:402-397-6600
Practice Address - Fax:402-397-8318
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111142363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026480100Medicaid
IA1730400631Medicaid
NE47068731799Medicaid
NE10026301600Medicaid
NE47068731799Medicaid
NE47068731799Medicaid