Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 30679 | NE |
NPI | 1619265642 |
---|---|
Provider Name | Angela M Osmolak |
First Address | Virginia Beach, VA 23450-0190 |
Second Address | Omaha, NE 68114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 08/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025044400 | (05) | NE |
10026485711 | (05) | NE |
1619265642 | (05) | IA |