Provider Demographics
NPI:1669844916
Name:GANGWISH, TAMAKA K (APRN-NP)
Entity type:Individual
Prefix:
First Name:TAMAKA
Middle Name:K
Last Name:GANGWISH
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:TAMAKA
Other - Middle Name:K
Other - Last Name:PEKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:926 E E ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6617
Mailing Address - Country:US
Mailing Address - Phone:402-303-8802
Mailing Address - Fax:402-487-0599
Practice Address - Street 1:926 E E ST STE 100
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6617
Practice Address - Country:US
Practice Address - Phone:402-303-8802
Practice Address - Fax:402-487-0599
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily