Provider Demographics
NPI:1841006194
Name:VONTZ, MICHAEL A
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:VONTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74750 ROAD 413
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:NE
Mailing Address - Zip Code:69028-5031
Mailing Address - Country:US
Mailing Address - Phone:308-320-0710
Mailing Address - Fax:
Practice Address - Street 1:74750 ROAD 413
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:NE
Practice Address - Zip Code:69028
Practice Address - Country:US
Practice Address - Phone:308-320-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion