Provider Demographics
NPI:1366728198
Name:VANDER TUIG, BRENDA F (APRN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:F
Last Name:VANDER TUIG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67250
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7250
Mailing Address - Country:US
Mailing Address - Phone:402-328-2907
Mailing Address - Fax:888-965-0959
Practice Address - Street 1:3900 PINE LAKE RD
Practice Address - Street 2:STE 5
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5489
Practice Address - Country:US
Practice Address - Phone:402-413-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075927913Medicaid