Healthcare Provider Details

I. General information

NPI: 1639191067
Provider Name (Legal Business Name): LYNETTE K VERZAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY ROAD SUITE 1300
OMAHA NE
68124
US

IV. Provider business mailing address

17445 ARBOR STREET SUITE 310
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-3110
  • Fax: 402-393-4499
Mailing address:
  • Phone: 308-865-2808
  • Fax: 308-865-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number987
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: