Basic Information
| Provider Information | |||||||||
| NPI: | 1366728198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDER TUIG | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 67250 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685067250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023282907 | ||||||||
| FaxNumber: | 8889650959 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 PINE LAKE RD | ||||||||
| Address2: | STE 5 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685165489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024136706 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2011 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 111313 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 47075927913 | 05 | NE | MEDICAID |