Healthcare Provider Details

I. General information

NPI: 1285791186
Provider Name (Legal Business Name): JOYCE VACEK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 W BROADWAY STE 9
COUNCIL BLUFFS IA
51501-3605
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 712-328-9100
  • Fax:
Mailing address:
  • Phone: 402-398-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number702
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: