Healthcare Provider Details

I. General information

NPI: 1477759348
Provider Name (Legal Business Name): THE EXPRESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 PINE LAKE RD
LINCOLN NE
68512-3632
US

IV. Provider business mailing address

PO BOX 23048
LINCOLN NE
68542
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-2094
  • Fax: 402-420-2095
Mailing address:
  • Phone: 402-420-2094
  • Fax: 402-420-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETTE GRACE TUCKER
Title or Position: OPERATIONS MANAGER
Credential: APRN
Phone: 402-440-1312