Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 111152 | NE |
NPI | 1053624767 |
---|---|
Provider Name | Amber L Van Dyke |
First Address | Papillion, NE 68046-8024 |
Second Address | Omaha, NE 68198-7740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2010 |
Last Update Date | 22/07/2010 |