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General NPI Number Information
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NPI Number | 1669781225
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Entity Type | Organization
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Legal Business Name | JANA VAN WIE, M.D., P.C.
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 1917 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4642
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Country | US
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Telephone | 308-384-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4642
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Country | US
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Telephone | 308-384-3457
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANA G VAN WIE
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Credential | M.D.
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Telephone | 308-384-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16706
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License Number State | NE
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