Healthcare Provider Details

I. General information

NPI: 1366728198
Provider Name (Legal Business Name): BRENDA F VANDER TUIG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PINE LAKE RD STE 5
LINCOLN NE
68516-5489
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-6706
  • Fax:
Mailing address:
  • Phone: 402-328-2907
  • Fax: 888-965-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111313
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: