Provider Demographics
NPI:1558435370
Name:NEBEN, JAIMEE VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIMEE
Middle Name:VICTORIA
Last Name:NEBEN
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 1:2478 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1204
Mailing Address - Country:US
Mailing Address - Phone:262-391-8866
Mailing Address - Fax:
Practice Address - Street 1:2478 N 72ND ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1204
Practice Address - Country:US
Practice Address - Phone:262-391-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48360-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ735AMedicare PIN
CAP00791685Medicare PIN