Provider Demographics
NPI:1285085365
Name:TOOLEY, JAKE (DO)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:TOOLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4696 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2041
Mailing Address - Country:US
Mailing Address - Phone:402-321-8185
Mailing Address - Fax:
Practice Address - Street 1:985582 NEBRASKA MEDICAL CTR
Practice Address - Street 2:CU DEPARTMENT OF PSYCHIATRY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5582
Practice Address - Country:US
Practice Address - Phone:402-552-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry