Provider Demographics
NPI:1407580665
Name:FISCHER VAZQUEZ, MARI LAURA (CRNA, DNAP)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:LAURA
Last Name:FISCHER VAZQUEZ
Suffix:
Gender:F
Credentials:CRNA, DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 S 194TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4228
Mailing Address - Country:US
Mailing Address - Phone:309-830-9766
Mailing Address - Fax:
Practice Address - Street 1:1535 S 52ND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1304
Practice Address - Country:US
Practice Address - Phone:402-481-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE82237163W00000X
COC-APN.0100862-C-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse