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5550 S 59th St Ste 21, Lincoln, NE 68516-2398 | |
(402) 858-2052 | |
(402) 817-1743 |
Full Name | |
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Type | Facility |
Speciality | Nurse Practitioner - Family |
Location | 5550 S 59th St Ste 21, Lincoln, Nebraska |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1750094512 | NPI | - | NPPES |
10027799200 | Medicaid | NE |
Taxonomy | Type | License (State) | Status |
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225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
Provider Name | Mary Jane Glade |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538354907 PECOS PAC ID: 6103959283 Enrollment ID: I20100727000863 |
Provider Name | Bethany Vitko |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1366998924 PECOS PAC ID: 8123314259 Enrollment ID: I20160915001370 |
Mailing Address | Practice Location Address |
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5550 S 59th St Ste 21, Lincoln, NE 68516-2398 Ph: (402) 416-1632 | 5550 S 59th St Ste 21, Lincoln, NE 68516-2398 Ph: (402) 858-2052 |