Provider Demographics
NPI:1093727075
Name:VANENGEN, FLOYD G (RP)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:G
Last Name:VANENGEN
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1, BOX 952
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NE
Mailing Address - Zip Code:68301-9801
Mailing Address - Country:US
Mailing Address - Phone:402-988-7145
Mailing Address - Fax:
Practice Address - Street 1:RR 1
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NE
Practice Address - Zip Code:68301-9801
Practice Address - Country:US
Practice Address - Phone:402-988-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47066741800Medicaid
NE08952OtherBC/BS
NE0415010001Medicare NSC