Healthcare Provider Details

I. General information

NPI: 1912417841
Provider Name (Legal Business Name): LACEY S JANE SNYDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY S JANE ROESLER

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S 144TH ST STE 280
OMAHA NE
68144-5252
US

IV. Provider business mailing address

2727 S 144TH ST STE 280
OMAHA NE
68144-5252
US

V. Phone/Fax

Practice location:
  • Phone: 402-778-5490
  • Fax: 402-614-1404
Mailing address:
  • Phone: 402-778-5490
  • Fax: 402-614-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112343
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: