Healthcare Provider Details

I. General information

NPI: 1396228268
Provider Name (Legal Business Name): CYNTHIA KAY VENDITTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 MEREDITH AVE
OMAHA NE
68111-2327
US

IV. Provider business mailing address

2504 MEREDITH AVE
OMAHA NE
68111-2327
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-2841
  • Fax: 531-299-2059
Mailing address:
  • Phone: 531-299-2841
  • Fax: 531-299-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number61270
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: