Healthcare Provider Details

I. General information

NPI: 1962411330
Provider Name (Legal Business Name): GWENDOLYN JOURNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E 14TH ST SUITE 100
HASTINGS NE
68901-3200
US

IV. Provider business mailing address

PO BOX 1423 223 E 14TH SUITE 100
HASTINGS NE
68902-1423
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2929
  • Fax: 402-463-2939
Mailing address:
  • Phone: 402-463-2929
  • Fax: 402-463-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110741
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: