Provider Demographics
NPI:1255220489
Name:PUSTOVIT, VLADIMIR IVANOVICH
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:IVANOVICH
Last Name:PUSTOVIT
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 1:2440 SW PAUL WHITEHEAD LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1861
Mailing Address - Country:US
Mailing Address - Phone:402-875-3346
Mailing Address - Fax:
Practice Address - Street 1:6321 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-2201
Practice Address - Country:US
Practice Address - Phone:402-875-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care