Provider Demographics
NPI:1639265192
Name:HERRMAN, VICKI A (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:A
Last Name:HERRMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:7205 W CENTER RD STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-392-7684
Practice Address - Fax:531-355-0001
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-14375208000000X
NE20322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA521732Medicaid
HIMD-14375OtherMD LIC
NE554OtherBCBS
IA96916OtherBCBS
NE9738OtherMIDLANDS CHOICE
NE47068937213Medicaid