Individual
JASON THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4615 MEREDETH ST APT 6, LINCOLN, NE 68506-4973
(347) 449-1387
Mailing address
4615 MEREDETH ST APT 6, LINCOLN, NE 68506-4973
(347) 449-1387
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/27/2019
Last updated
09/09/2019
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