Provider Demographics
NPI:1962032292
Name:VRBICKY, BONNIE LANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LANE
Last Name:VRBICKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:LANE
Other - Last Name:SISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:717 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3113
Mailing Address - Country:US
Mailing Address - Phone:402-852-6637
Mailing Address - Fax:
Practice Address - Street 1:1200 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1212
Practice Address - Country:US
Practice Address - Phone:402-375-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant