Provider Demographics
NPI:1306405261
Name:VANTIPALLI, PRAVEENA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:PRAVEENA
Middle Name:
Last Name:VANTIPALLI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W LEOTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6578
Mailing Address - Country:US
Mailing Address - Phone:308-534-4440
Mailing Address - Fax:
Practice Address - Street 1:500 W LEOTA ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6578
Practice Address - Country:US
Practice Address - Phone:308-534-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8507207Q00000X
NE34072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine