Provider Demographics
NPI:1750681870
Name:DEPARTMENT OF VETERAN AFFAIRSNEBRASKA WESTERN IOWA HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERAN AFFAIRSNEBRASKA WESTERN IOWA HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RD LMNT
Authorized Official - Phone:308-389-5107
Mailing Address - Street 1:2201 NORTH BROADWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:308-389-5107
Mailing Address - Fax:
Practice Address - Street 1:2201 NORTH BROADWELL AVENUE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-389-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE726133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty