Healthcare Provider Details

I. General information

NPI: 1114405040
Provider Name (Legal Business Name): VICTORIA M HAGERICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA M ALAI

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-4360
  • Fax: 402-955-4364
Mailing address:
  • Phone: 402-955-5400
  • Fax: 402-955-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2260
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: