Healthcare Provider Details

I. General information

NPI: 1073322467
Provider Name (Legal Business Name): LAURYN VACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 E 5TH ST
PAPILLION NE
68046-2208
US

IV. Provider business mailing address

8006 S 68TH STREET CIR
LA VISTA NE
68128-4365
US

V. Phone/Fax

Practice location:
  • Phone: 719-251-6935
  • Fax:
Mailing address:
  • Phone: 402-885-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberH13972224
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: