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General NPI Number Information
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NPI Number | 1720062458
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Entity Type | Individual
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Provider Name | JANA G VAN WIE MD
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Gender | Female
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 3016 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4109
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Country | US
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Telephone | 308-381-8546
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Fax | 308-381-8550
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Provider Business Mailing Address
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Address Line | 3016 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4109
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Country | US
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Telephone | 308-382-8546
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Fax | 308-381-8546
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2801-16706
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License Number State | NE
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