Healthcare Provider Details

I. General information

NPI: 1497298731
Provider Name (Legal Business Name): LUKE THEIMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 13TH ST
LINCOLN NE
68508-3533
US

IV. Provider business mailing address

2633 P ST
LINCOLN NE
68503-3528
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-5161
  • Fax: 402-475-3300
Mailing address:
  • Phone: 402-475-8717
  • Fax: 402-475-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: