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NPI Code Detail

MEDICARE: MARIA LYNN VAN DYKE PA-C

MEDICARE: MARIA LYNN VAN DYKE PA-C
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
1363A00000XPhysician Assistant2650NE

General Provider Information

NPI Number : 1326688193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA LYNN VAN DYKE PA-C
Provider Business Mailing Address
First Line : 3307 BARADA ST
Second Line :
City : FALLS CITY
State : NE
Zip : 68355-2470
Country : US
Telephone Number : 402-245-6510
Fax Number : 402-245-6707
Provider Business Practice Location Address
First Line : 3307 BILL SCHOCK BLVD
Second Line :
City : FALLS CITY
State : NE
Zip : 68355-2428
Country : US
Telephone Number : 402-245-6510
Fax Number : 402-245-6707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2020
Last Update Date : 09/15/2025

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