Provider Demographics
NPI:1861214512
Name:JESSEN BUETOW, JILL RENEE (RN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:JESSEN BUETOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 S 157TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2519
Mailing Address - Country:US
Mailing Address - Phone:402-203-9145
Mailing Address - Fax:
Practice Address - Street 1:4519 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1817
Practice Address - Country:US
Practice Address - Phone:531-299-2781
Practice Address - Fax:531-299-2818
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62051163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse