Healthcare Provider Details

I. General information

NPI: 1942907399
Provider Name (Legal Business Name): TD NURSE PRACTITIONER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4972 COUNTY ROAD 38
FORT CALHOUN NE
68023-5054
US

IV. Provider business mailing address

4972 COUNTY ROAD 38
FORT CALHOUN NE
68023-5054
US

V. Phone/Fax

Practice location:
  • Phone: 402-641-8822
  • Fax:
Mailing address:
  • Phone: 402-641-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESA ANN-ROTH DOWLING
Title or Position: OWNER/NURSE PRACTITIONER
Credential: ARNP
Phone: 402-641-8822