Provider Demographics
NPI:1538032131
Name:VITAL ROOTS WELLNESS LLC
Entity type:Organization
Organization Name:VITAL ROOTS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RAFTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-396-2935
Mailing Address - Street 1:14450 EAGLE RUN DR STE 270
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1493
Mailing Address - Country:US
Mailing Address - Phone:402-396-2935
Mailing Address - Fax:402-396-2935
Practice Address - Street 1:14450 EAGLE RUN DR STE 270
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1493
Practice Address - Country:US
Practice Address - Phone:402-396-2935
Practice Address - Fax:402-396-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty