1285742866 NPI number — PATRICIA L VERMAAS APRN, BC

Table of content: PATRICIA L VERMAAS APRN, BC (NPI 1285742866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285742866 NPI number — PATRICIA L VERMAAS APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERMAAS
Provider First Name:
PATRICIA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285742866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-328-2907
Provider Business Mailing Address Fax Number:
402-328-2907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8511 AUGUSTA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68526-9572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-328-2907
Provider Business Practice Location Address Fax Number:
888-965-0959
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  110260 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 110260 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0570077 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47084496100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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