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General NPI Number Information
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NPI Number | 1922507086
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Entity Type | Individual
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Provider Name | ANDREA MARIE VACHA APRN
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Gender | Female
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 350 W 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2592
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Country | US
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Telephone | 402-721-7077
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Fax | 402-721-7324
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Provider Business Mailing Address
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Address Line | 7261 MERCY RD
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City | OMAHA
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State | NE
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Zip | 68124-2311
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Country | US
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Telephone |
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 61243
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 112407
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License Number State | NE
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