Provider Demographics
NPI:1568200996
Name:VODICKA, HEATHER (LPN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:VODICKA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 1ST CORSO
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-2238
Mailing Address - Country:US
Mailing Address - Phone:402-874-1589
Mailing Address - Fax:
Practice Address - Street 1:824 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1370
Practice Address - Country:US
Practice Address - Phone:402-873-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24044164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse