SHANE VERL THEOBALD (NPI# 1174783492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174783492 |
| Entity Type | Individual |
| Full Name | SHANE VERL THEOBALD |
| Credential | CRNA |
| Practice Address |
151 W 200 N Vernal UT 84078-1907 |
| Mailing Address |
Po Box 790164 Vernal UT 84079-0164 |
| Practice Telephone | 4357811519 |
| Practice Fax Number | 4357811519 |
| Mailing Telephone | 4357811519 |
| Mailing Fax Number | 4357811519 |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 4938276-4406 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760415947 | Shane Theobald | Optometrist | 1717 W. Chandler Blvd, Chandler, AZ 85224 | 2006-07-09 |
| Street Address |
151 W 200 N |
| City | VERNAL |
| State | UT |
| Zip Code | 84078-1907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174573679 | Hilary J. Sarhatt | Family Medicine | 151 W 200 N, Vernal, UT 84078-1907 | 2006-05-12 |
| 1104055821 | Brett Wallace Bulloch | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1908 | 2009-07-02 |
| 1063629830 | Dean G Anderson | Emergency Medicine | 151 W 200 N, Ashley Regional Medical Center, Vernal, UT 84078-1907 | 2007-05-17 |
| 1285753541 | Basin Anesthesia Associates, Inc. | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-28 |
| 1417075102 | Michael Arthur Hartman | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-27 |
| 1700904455 | Dee Lewis Bambrough | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-27 |
| 1790817013 | Larry T Wilcken | Family Medicine | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-12 |
| 1659409159 | David Andrew Bestenelhner | Pharmacist | 151 W 200 N, Vernal, UT 84078-1907 | 2007-02-28 |
| 1962530477 | Ben Dogan Semadeni | Pharmacist | 151 W 200 N, Vernal, UT 84078-1907 | 2007-02-28 |
| 1568563591 | Bruce A Daniel | Emergency Medicine | 151 W 200 N, Vernal, UT 84078-1907 | 2006-09-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479748 | Wade Oliver Moulton | Pharmacist | 1080 W Hwy 40, Vernal, UT 84078 | 2019-10-28 |
| 1841610383 | Allegiance Addiction Recovery Center | Substance Abuse Rehabilitation Facility | 4430 N Little Valley Road, Vernal, UT 84078 | 2014-04-23 |
| 1689008773 | Ashley Valley Physician Practice, LLC | Occupational Therapist | 1680 W Highway 40 Ste 202, Vernal, UT 84078 | 2013-08-26 |
| 1528371796 | Terry L Smith | Counselor | 1140 W 500 S #9, Vernal, UT 84078 | 2010-07-16 |
| 1619280880 | Cicile M Rios | Counselor | 1140 W 800 S #9, Vernal, UT 84078 | 2010-07-16 |
| 1265754840 | Marjorie Elaine Gardner | Licensed Practical Nurse | 133 S 500 East, Vernal, UT 84078 | 2010-02-23 |
| 1528205853 | Robert Kirkham Jolley | Dentist | 40 West 100 North, Vernal, UT 84078 | 2009-01-08 |
| 1740482025 | Ashley Valley Physician Practice, LLC | Family Medicine | 175 N. 100 W., Suite 202, Vernal, UT 84078 | 2007-05-31 |
| 1265646459 | Ashley Valley Medical Center | Pharmacy | 151 W. 200 N., Vernal, UT 84078 | 2007-05-09 |
| 1629122692 | Brian Prentice Callahan | Dentist | 779 West Us Highway 40, Vernal, UT 84078 | 2007-01-23 |
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| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942684162 | Dustin Todd Bradley | Nurse Anesthetist, Certified Registered | 808 W 300 N, Vernal, UT 84078-3812 | 2015-07-17 |
| 1336268655 | Pauline Frome | Nurse Anesthetist, Certified Registered | 3021 E 5000 S, Vernal, UT 84078-9344 | 2007-03-28 |
| 1922311133 | Edwin Bulloch | Nurse Anesthetist, Certified Registered | 150 W 100 N, Vernal, UT 84078-2036 | 2010-07-16 |
| 1104055821 | Brett Wallace Bulloch | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1908 | 2009-07-02 |
| 1285753541 | Basin Anesthesia Associates, Inc. | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-28 |
| 1417075102 | Michael Arthur Hartman | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-27 |
| 1700904455 | Dee Lewis Bambrough | Nurse Anesthetist, Certified Registered | 151 W 200 N, Vernal, UT 84078-1907 | 2007-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972116523 | Sleepy Smiles LLC | Nurse Anesthetist, Certified Registered | 530 W 465 N Ste 703, Providence, UT 84332-8006 | 2020-08-24 |
| 1083223523 | Mt Olympus Anesthesia | Nurse Anesthetist, Certified Registered | 4035 S Splendor Cir, Salt Lake City, UT 84124-2177 | 2020-07-30 |
| 1922627975 | Nic-sedation Pllc | Nurse Anesthetist, Certified Registered | 7138 S Highland Dr Ste 109, Salt Lake City, UT 84121-3776 | 2020-04-09 |
| 1871139972 | Suzanne Enos Tremblay | Nurse Anesthetist, Certified Registered | 1051 E 100 N, Lindon, UT 84042-2268 | 2019-11-23 |
| 1629638101 | Cloud Nine Sedations | Nurse Anesthetist, Certified Registered | 5465 Aspen Meadow Ln, Mountain Green, UT 84050-6766 | 2019-06-18 |
| 1558927376 | Rocky Point Anesthesia | Nurse Anesthetist, Certified Registered | 6811 Firth Farm Rd, South Weber, UT 84405-7193 | 2019-05-16 |
| 1083120059 | Dallin Marchant | Nurse Anesthetist, Certified Registered | 1954 S 2600 E, Slc, UT 84108-3334 | 2017-12-28 |
| 1477068294 | Michael G Bergeson | Nurse Anesthetist, Certified Registered | 136 W 1300 North Cir, Centerville, UT 84014-1400 | 2017-12-04 |
| 1356886832 | Jeremy Henrie | Nurse Anesthetist, Certified Registered | 10660 S Rembrandt Ln, Sandy, UT 84070-5224 | 2016-12-20 |
| 1063961928 | Chase Bazil | Nurse Anesthetist, Certified Registered | 15 N 100 W, Salem, UT 84653-9541 | 2016-10-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.