Healthcare Provider Details

I. General information

NPI: 1972426237
Provider Name (Legal Business Name): MELANIE VANNORNAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 LAKESIDE HILLS CT
OMAHA NE
68130-4664
US

IV. Provider business mailing address

12202 SELDIN DR
OMAHA NE
68144-3963
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-8111
  • Fax:
Mailing address:
  • Phone: 402-359-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number92324
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: