Healthcare Provider Details

I. General information

NPI: 1992052104
Provider Name (Legal Business Name): TERRA NICHOLE VEJRASKA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRA NICHOLE LEWIS APRN

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 VILLAGE DR
LINCOLN NE
68516-4714
US

IV. Provider business mailing address

6050 VILLAGE DR
LINCOLN NE
68516-4714
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-8581
  • Fax: 402-421-8594
Mailing address:
  • Phone: 402-421-8581
  • Fax: 402-421-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number111396
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: