Provider Demographics
NPI:1174328355
Name:JASA, DANA RENEE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RENEE
Last Name:JASA
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 1:2757 W ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-2630
Mailing Address - Country:US
Mailing Address - Phone:402-890-4891
Mailing Address - Fax:
Practice Address - Street 1:5014 E PLATTEVIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:NE
Practice Address - Zip Code:68016-2418
Practice Address - Country:US
Practice Address - Phone:402-670-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health