Provider Demographics
NPI:1437116084
Name:JACOBSEN, DOROTHEA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHEA
Middle Name:Y
Last Name:JACOBSEN
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 1:7441 O ST
Mailing Address - Street 2:STE 400
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2468
Mailing Address - Country:US
Mailing Address - Phone:402-488-7400
Mailing Address - Fax:
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:STE 400
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2468
Practice Address - Country:US
Practice Address - Phone:402-488-7400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH90816Medicare UPIN
NE279039Medicare ID - Type UnspecifiedASHLAND
NE279037Medicare ID - Type UnspecifiedLINCOLN