Provider Demographics
NPI:1326249749
Name:THOMSEN, JEAN ANN (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1378
Mailing Address - Country:US
Mailing Address - Phone:402-332-8381
Mailing Address - Fax:308-568-7454
Practice Address - Street 1:933 E PIERCE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4626
Practice Address - Country:US
Practice Address - Phone:712-396-6311
Practice Address - Fax:712-396-4389
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-39959207ZP0102X
NE24017207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026527501Medicaid
IA1326249749Medicaid
IA1326249749Medicaid