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General NPI Number Information
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NPI Number | 1972625408
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Entity Type | Individual
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Provider Name | BONNIE C. VANDENBERG R.P.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 7328 MAPLE ST
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City | OMAHA
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State | NE
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Zip | 68134-6829
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Country | US
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Telephone | 402-391-2659
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Fax |
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Provider Business Mailing Address
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Address Line | 7328 MAPLE ST
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City | OMAHA
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State | NE
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Zip | 68134-6829
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Country | US
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Telephone | 402-391-2659
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11712
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 043041
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1-11548
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License Number State | KS
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