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NPI Code Detail

MEDICARE: MRS. JO VON THEOBALD RN

MEDICARE: MRS. JO VON THEOBALD RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN0000155273TN

General Provider Information

NPI Number : 1912188350
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JO VON THEOBALD RN
Provider Business Mailing Address
First Line : 1909 HAMPSHIRE PIKE
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-5650
Country : US
Telephone Number : 931-388-5757
Fax Number :
Provider Business Practice Location Address
First Line : 1909 HAMPSHIRE PIKE
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-5650
Country : US
Telephone Number : 931-388-5757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2007
Last Update Date : 11/14/2007

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