Individual
MR. WILLIAM SCOTT VAN WIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1917 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4642
(308) 382-5100
(308) 382-5155
Mailing address
50 KUESTER LK, GRAND ISLAND, NE 68801-8609
(308) 384-3457
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026008900
—
NE
01
—
650150001
MEDICARE PTAN
NE
Enumeration date
09/20/2011
Last updated
09/20/2011
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