Provider Demographics
NPI:1679381800
Name:JELINEK, JUSTIN MICHEAL
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MICHEAL
Last Name:JELINEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1221
Mailing Address - Country:US
Mailing Address - Phone:308-385-5775
Mailing Address - Fax:308-385-5780
Practice Address - Street 1:2536 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1221
Practice Address - Country:US
Practice Address - Phone:308-385-5775
Practice Address - Fax:308-385-5780
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion