Healthcare Provider Details

I. General information

NPI: 1174531495
Provider Name (Legal Business Name): SUZANNE M. VANDENHUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE M. SMYKACZ MD

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 S 86TH ST
LINCOLN NE
68526-9260
US

IV. Provider business mailing address

2222 S 16TH ST SUITE 400A
LINCOLN NE
68502-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8500
  • Fax: 402-483-8501
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22281
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: