Individual
JANE M. THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8303 DODGE ST, OMAHA, NE 68114-4108
(402) 354-8350
(402) 354-8355
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
22656
NE
2084P0800X
Psychiatry Physician
36298
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0724039
—
IA
05
—
1902857733
—
IA
05
—
47037660433
—
NE
Enumeration date
05/15/2006
Last updated
12/13/2013
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