Healthcare Provider Details

I. General information

NPI: 1962032292
Provider Name (Legal Business Name): BONNIE LANE VRBICKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BONNIE LANE SISCO

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLEVUE MEDICAL CENTER DR
BELLEVUE NE
68123-1591
US

IV. Provider business mailing address

301 CHARLESTON DR
PAPILLION NE
68133-2846
US

V. Phone/Fax

Practice location:
  • Phone: 402-763-3000
  • Fax:
Mailing address:
  • Phone: 402-852-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: