Provider Demographics
NPI:1053367979
Name:WENZEL, VAUGHAN A (PA-C)
Entity type:Individual
Prefix:
First Name:VAUGHAN
Middle Name:A
Last Name:WENZEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046
Mailing Address - Country:US
Mailing Address - Phone:402-331-5747
Mailing Address - Fax:
Practice Address - Street 1:1111 SO 84TH ST, MIDLAND'S COMMUNITY HOSPITAL
Practice Address - Street 2:EMERGENCY DEPT (CARE OF DR RON SARNO, MD)
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-593-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58972Medicare UPIN
278262Medicare ID - Type Unspecified