Basic Information
| Provider Information | |||||||||
| NPI: | 1235808445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YACAMAN STRUBLE | ||||||||
| FirstName: | JAZMIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2107 N CLARKSON ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680252625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023178659 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8207 NORTHWOODS DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685052093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024843440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2021 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2571 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.