Provider Demographics
NPI:1366455974
Name:VANDERNECK, CHRISTOPHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:VANDERNECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-8902
Mailing Address - Country:US
Mailing Address - Phone:402-723-4512
Mailing Address - Fax:402-723-4520
Practice Address - Street 1:1621 FRONT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-8902
Practice Address - Country:US
Practice Address - Phone:402-723-4512
Practice Address - Fax:402-723-4520
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE21487Medicaid
NE275473Medicare ID - Type UnspecifiedMEDICARE #
NENE21487Medicaid