Healthcare Provider Details

I. General information

NPI: 1184906422
Provider Name (Legal Business Name): ANGELA MAE PATRICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ANGELA MAE ZWICKL

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 CENTRAL AVE
GRANT NE
69140-3099
US

IV. Provider business mailing address

7 PARKWAY AVE
GRANT NE
69140-3205
US

V. Phone/Fax

Practice location:
  • Phone: 308-352-7100
  • Fax: 308-352-7290
Mailing address:
  • Phone: 308-352-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111300
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: