Provider Demographics
NPI:1316822315
Name:FENNER, SOLOMON JARRETT
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:JARRETT
Last Name:FENNER
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 1:4324 JERRY GILBERT CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1114
Mailing Address - Country:US
Mailing Address - Phone:402-707-3402
Mailing Address - Fax:
Practice Address - Street 1:4324 JERRY GILBERT CIR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1114
Practice Address - Country:US
Practice Address - Phone:402-707-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant