SHANE VERL THEOBALD

VERNAL, UT
NPI1174783492
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: UT  4938276-4406)
Enumeration Date2008-06-10
Last Update Date2008-06-10
Business Address
-- SHANE VERL THEOBALD CRNA
151 W 200 N
VERNAL, UT 84078-1907
Phone number: 435-781-1519
Mailing Address
-- SHANE VERL THEOBALD CRNA
PO BOX 790164
VERNAL, UT 84079-0164
Phone number: 435-781-1519
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