MEDICARE: VICKI LYNN STRAW EMT, MEDIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1053625103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LYNN STRAW EMT, MEDIC

Provider Business Mailing Address
First Line	:	4316 S 15TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68107-2118
Country	:	US
Telephone Number	:	402-315-3757
Fax Number	:

Provider Business Practice Location Address
First Line	:	4316 S 15TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68107-2118
Country	:	US
Telephone Number	:	402-315-3757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2010
Last Update Date	:	07/31/2010

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