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 |