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NPI Code Detail

MEDICARE: MOLLI MAE VASA

MEDICARE: MOLLI MAE VASA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1235838715
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLI MAE VASA
Provider Business Mailing Address
First Line : 124 S 24TH ST STE 230
Second Line :
City : OMAHA
State : NE
Zip : 68102-1226
Country : US
Telephone Number : 402-599-2056
Fax Number : 402-491-5075
Provider Business Practice Location Address
First Line : 1420 E MILITARY AVE
Second Line :
City : FREMONT
State : NE
Zip : 68025-5300
Country : US
Telephone Number : 402-721-1774
Fax Number : 402-721-9689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2023
Last Update Date : 02/23/2023

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Directions to “ MOLLI MAE VASA ” Practice Location

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