Healthcare Provider Details

I. General information

NPI: 1073605861
Provider Name (Legal Business Name): STACY L. VOCELKA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST
OMAHA NE
68114-4108
US

IV. Provider business mailing address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-4000
  • Fax:
Mailing address:
  • Phone: 402-391-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100936
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: