Healthcare Provider Details

I. General information

NPI: 1447326384
Provider Name (Legal Business Name): DENISE M DRVOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 BOYS TOWN HOSPITAL RD
BOYS TOWN NE
68010-7513
US

IV. Provider business mailing address

3330 N 129TH CIR
OMAHA NE
68164-4238
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number17523
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: