Provider Demographics
NPI:1053118844
Name:TEATER, JAKE
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:TEATER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 OAKCREEK DR # NE68528
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-1587
Mailing Address - Country:US
Mailing Address - Phone:402-817-4959
Mailing Address - Fax:
Practice Address - Street 1:1139 N 101ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68527-3714
Practice Address - Country:US
Practice Address - Phone:303-263-2614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist