Healthcare Provider Details

I. General information

NPI: 1861268856
Provider Name (Legal Business Name): EMILY MAIHLI VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N 27TH ST
LINCOLN NE
68521-1194
US

IV. Provider business mailing address

53190 230TH ST
GLENWOOD IA
51534-6147
US

V. Phone/Fax

Practice location:
  • Phone: 402-438-3015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18110
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: