Healthcare Provider Details

I. General information

NPI: 1790978583
Provider Name (Legal Business Name): NELIGH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 R ST
NELIGH NE
68756-1022
US

IV. Provider business mailing address

1108 R ST
NELIGH NE
68756-1022
US

V. Phone/Fax

Practice location:
  • Phone: 402-887-4681
  • Fax:
Mailing address:
  • Phone: 402-887-4681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNE

VIII. Authorized Official

Name: BRENDA KORTH-WURDINGER
Title or Position: OWNER/MANAGER
Credential: PA-C
Phone: 402-887-4681