Healthcare Provider Details

I. General information

NPI: 1063903946
Provider Name (Legal Business Name): JACQUELINE DAUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

983285 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5524
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4344
  • Fax:
Mailing address:
  • Phone: 402-559-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number35630
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR76816
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: