Provider Demographics
NPI:1215948591
Name:ESCH, JACQUELINE B (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:B
Last Name:ESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:B
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-315-5257
Mailing Address - Fax:615-692-0547
Practice Address - Street 1:2915 GRANT STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111
Practice Address - Country:US
Practice Address - Phone:402-457-1200
Practice Address - Fax:402-453-1970
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22604207Q00000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4706671500Medicaid
NE4706671500Medicaid
D06028Medicare UPIN