Provider Demographics
NPI:1053116111
Name:BYRON, JONELL
Entity type:Individual
Prefix:
First Name:JONELL
Middle Name:
Last Name:BYRON
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 1:1450 S 16TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2418
Mailing Address - Country:US
Mailing Address - Phone:402-631-7109
Mailing Address - Fax:
Practice Address - Street 1:1450 S 16TH ST APT 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2418
Practice Address - Country:US
Practice Address - Phone:402-631-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant