Provider Demographics
| NPI: | 1063140630 |
|---|---|
| Name: | VIBRANCE FAMILY HEALTH CARE |
| Entity type: | Organization |
| Organization Name: | VIBRANCE FAMILY HEALTH CARE |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | APRN |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KATIE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PETERS SETTJE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | APRN |
| Authorized Official - Phone: | 308-281-2544 |
| Mailing Address - Street 1: | 416 N DIERS AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GRAND ISLAND |
| Mailing Address - State: | NE |
| Mailing Address - Zip Code: | 68803-4979 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 308-281-2544 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 416 N DIERS AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | GRAND ISLAND |
| Practice Address - State: | NE |
| Practice Address - Zip Code: | 68803-4979 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 308-281-2544 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-08-11 |
| Last Update Date: | 2022-08-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |