Provider Demographics
NPI:1174531495
Name:VANDENHUL, SUZANNE M (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:VANDENHUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SMYKACZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3796
Mailing Address - Country:US
Mailing Address - Phone:402-483-8590
Mailing Address - Fax:402-483-8599
Practice Address - Street 1:4333 S 86TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9260
Practice Address - Country:US
Practice Address - Phone:402-483-8500
Practice Address - Fax:402-483-8501
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
237614OtherMIDLANDS CHOICE
NE47078085732Medicaid
NE470780857 32Medicaid
01-03824OtherUHC
NE01-05357OtherUHC
NE00455OtherBCBS
080188325Medicare PIN
NE099570049Medicare PIN
NE47078085732Medicaid
01-03824OtherUHC
080193872Medicare PIN