Individual
DR. VICTORIA ANNE GENGENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
115 W 3RD ST, GRANT, NE 69140-3107
(308) 352-4424
Mailing address
115 W 3RD ST, GRANT, NE 69140-3107
(308) 352-4424
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1336
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H13425020
DRIVERS LICENSE NUMBER
NE
Enumeration date
09/30/2009
Last updated
09/30/2009
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