Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 12635 | NE |
NPI | 1003893058 |
---|---|
Provider Name | Dr. Eileen C Vautravers |
First Address | Lincoln, NE 68506-2944 |
Second Address | Lincoln, NE 68505-3092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47079049100 | (05) | NE |