Healthcare Provider Details

I. General information

NPI: 1801703756
Provider Name (Legal Business Name): IRMA VAZQUEZ DE ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BROADMOOR DR
SOUTH SIOUX CITY NE
68776-3808
US

IV. Provider business mailing address

404 BROADMOOR DR
SOUTH SIOUX CITY NE
68776-3808
US

V. Phone/Fax

Practice location:
  • Phone: 402-404-4318
  • Fax:
Mailing address:
  • Phone: 402-404-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number175512
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: