Individual
PETULA CM VAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
985450 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-5450
(402) 559-8863
Mailing address
985450 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-5450
(402) 559-8863
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1109
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025289000
—
NE
Enumeration date
02/11/2009
Last updated
02/11/2009
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