Provider Demographics
NPI:1578372991
Name:DRAKE, JERENE FAYE
Entity type:Individual
Prefix:
First Name:JERENE
Middle Name:FAYE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JERENE
Other - Middle Name:FAYE
Other - Last Name:MANCHESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-2000
Mailing Address - Country:US
Mailing Address - Phone:308-728-3621
Mailing Address - Fax:
Practice Address - Street 1:420 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-2000
Practice Address - Country:US
Practice Address - Phone:308-728-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion