Provider Demographics
NPI:1053625103
Name:STRAW, VICKI LYNN (EMT, MEDIC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:STRAW
Suffix:
Gender:F
Credentials:EMT, MEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2118
Mailing Address - Country:US
Mailing Address - Phone:402-315-3757
Mailing Address - Fax:
Practice Address - Street 1:4316 S 15TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2118
Practice Address - Country:US
Practice Address - Phone:402-315-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider