Individual
SHANE VERL THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
151 W 200 N, VERNAL, UT 84078-1907
(435) 781-1519
(435) 781-1519
Mailing address
PO BOX 790164, VERNAL, UT 84079-0164
(435) 781-1519
(435) 781-1519
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4938276-4406
UT
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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