Healthcare Provider Details

I. General information

NPI: 1619882255
Provider Name (Legal Business Name): MICHELLE VANDEWALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 13TH ST
COLUMBUS NE
68601-4917
US

IV. Provider business mailing address

1800 W PASEWALK AVE
NORFOLK NE
68701-5650
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-0220
  • Fax: 402-644-4593
Mailing address:
  • Phone: 402-371-0220
  • Fax: 402-644-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: