Provider Demographics
NPI:1619774676
Name:VANDYKE, RONALD BERNARD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:BERNARD
Last Name:VANDYKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 JERRY GILBERT CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1114
Mailing Address - Country:US
Mailing Address - Phone:402-680-1011
Mailing Address - Fax:
Practice Address - Street 1:5022 S 114TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2329
Practice Address - Country:US
Practice Address - Phone:402-827-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty